Early Home Visits and Health Outcomes in Low-Income Mothers and Offspring: 18-Year Follow-Up of a Randomized Clinical Trial.
Early Home Visits and Health Outcomes in Low-Income Mothers and Offspring: 18-Year Follow-Up of a Randomized Clinical Trial.
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DOI：
10.1001/jamanetworkopen.2023.51752
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发表时间：
2024-01-02
影响因子：
13.8
通讯作者：
Olds, David
中科院分区：
文献类型：
--
作者：
Conti, Gabriella;Smith, Joyce;Anson, Elizabeth;Groth, Susan;Knudtson, Michael;Salvati, Andrea;Olds, David
护士的产前和婴儿期家访是否能减少低收入母亲及其12岁和18岁的第一个孩子的肥胖和高血压？在这项随机临床试验中，742名参与者，护士访问的女性后代在12岁和18岁时的肥胖和严重肥胖率低于对照组;护士访问的女性母亲在12岁和18岁时的1期和2期高血压率低于对照组。在男性后代或男性母亲中未发现这些结果的干预效应。这些研究结果表明，产前和婴儿期家访有望减少生活在极端贫困中的女性后代的肥胖症，并降低其母亲的高血压。这项随机临床试验旨在确定护士进行产前和婴儿期家访是否能减少低收入母亲及其子女的肥胖和高血压。低收入者肥胖和高血压的发病率可能更高。确定护士产前和婴儿期家访是否能减少母亲和子女的肥胖和高血压。这项在田纳西州孟菲斯的一个公共卫生保健系统进行的产前和婴儿护理之家访问的随机临床试验，从1990年6月1日至1991年8月31日，招募了742名以前没有活产并且至少有2个社会人口学风险因素（未婚、受教育不足12年、失业）的妇女。在怀孕期间登记时，727名母亲（98%）未婚，631名（85%）生活在联邦贫困线以下。在12岁和18岁的后代中，由对治疗不知情的工作人员评估母亲和后代的肥胖和高血压。数据分析于2021年7月1日至2023年10月31日进行。被分配到对照组的妇女在6、12和24个月大的孩子接受免费的产前护理和儿童发育筛查和转诊。被分配到护士探视的妇女得到运输和筛查，加上产前和婴幼儿护士家访。虽然在最初的试验设计中没有假设，但使用双重选择后套索方法分析了母亲及其子女在12岁和18岁时的肥胖和高血压。在随机分配的742名参与者中（平均[SD]年龄，18.1 [3.2]岁），对594名母亲和578名12岁子女以及618名母亲和629名18岁子女进行了访谈。分别对576名12岁和605名18岁的子女以及563名和598名12岁和18岁的母亲进行了肥胖评估。分别对568名12岁的子女和596名18岁的子女以及507名12岁和18岁的母亲进行了血压评估。在12岁和18岁的后代肥胖或高血压方面没有总体的治疗-对照差异，尽管与对照组相比，护士访问的雌性后代的肥胖患病率较低（校正相对危险度[ARR]，0.449; 95%CI，0.234 - 0.858; P =.003）和重度肥胖（ARR，0.185; 95%CI，0.046 - 0.748; P <.001）。在12岁和18岁时，护士访问组与对照组母亲的1期和2期高血压合并降低，差异仅限于女性母亲（1期：ARR，0.613 [95% CI，0.440 - 0.855; P =.001]; 2期：ARR，0.217 [95% CI，0.081 - 0.582; P <.001]）。对于肥胖和高血压的结果，在男性后代或男性的母亲中没有干预效果。自我报告的产妇健康与高血压的计划效果一致。在12岁和18岁的后代的临床试验随访中，护士访问的女性后代的肥胖率较低，女性的母亲的高血压率低于对照组。这些研究结果表明，生活在极端贫困中的女性母亲及其女性子女患慢性病的风险可以通过护士进行产前和婴幼儿家访来预防。ClinicalTrials.gov
Does prenatal and infancy home visitation by nurses reduce obesity and hypertension among mothers with very low income and their first-born offspring at 12 and 18 years following birth? In this randomized clinical trial of 742 participants, nurse-visited female offspring had lower rates of obesity and severe obesity at age 12 and 18 years combined than their control group counterparts; nurse-visited mothers of females had lower rates of stage 1 and stage 2 hypertension at child age 12 and 18 years combined compared with their control group counterparts. No intervention effect was found for these outcomes among male offspring or mothers of males. These findings suggest that prenatal and infancy home visitation holds promise for reducing obesity among female offspring living in extreme poverty and reducing their mothers’ hypertension. This randomized clinical trial determines whether prenatal and infancy home visits by nurses reduce obesity and hypertension in mothers with low income and their offspring. Individuals with low income may have heightened rates of obesity and hypertension. To determine whether prenatal and infancy home visitation by nurses reduces maternal and offspring obesity and hypertension. This randomized clinical trial of prenatal and infancy nurse home visitation in a public health care system in Memphis, Tennessee, enrolled 742 women with no previous live births and at least 2 sociodemographic risk factors (unmarried, <12 years of education, unemployed) from June 1, 1990, through August 31, 1991. At registration during pregnancy, 727 mothers (98%) were unmarried, and 631 (85%) lived below the federal poverty level. At offspring ages 12 and 18 years, maternal and offspring obesity and hypertension were assessed by staff masked to treatment. The data analysis was performed from July 1, 2021, to October 31, 2023. Women assigned to the control group received free transportation for prenatal care and child developmental screening and referral at child ages 6, 12, and 24 months. Women assigned to nurse visitation received transportation and screening plus prenatal and infant and toddler nurse home visits. Obesity and hypertension among mothers and their offspring at child ages 12 and 18 years, although not hypothesized in the original trial design, were analyzed using post–double selection lasso method. Of the 742 participants randomized (mean [SD] age, 18.1 [3.2] years), interviews were completed with 594 mothers and 578 offspring at child age 12 years and 618 mothers and 629 offspring at child age 18 years. Obesity was assessed for 576 offspring at age 12 years and 605 at age 18 years and for 563 and 598 mothers at child ages 12 and 18 years, respectively. Blood pressure was assessed for 568 offspring aged 12 years and 596 aged 18 years and 507 and 592 mothers at child ages 12 and 18 years, respectively. There were no overall treatment-control differences in offspring obesity or hypertension at ages 12 and 18 years combined, although nurse-visited female offspring, compared with controls, had a lower prevalence of obesity (adjusted relative risk [ARR], 0.449; 95% CI, 0.234-0.858; P = .003) and severe obesity (ARR, 0.185; 95% CI, 0.046-0.748; P < .001). There were reductions at ages 12 and 18 years combined for stage 1 and stage 2 hypertension for nurse-visited vs control group mothers, with differences limited to mothers of females (stage 1: ARR, 0.613 [95% CI, 0.440-0.855; P = .001]; stage 2: ARR, 0.217 [95% CI, 0.081-0.582; P < .001]). For both obesity and hypertension outcomes, there was no intervention effect among male offspring or the mothers of males. Self-reported maternal health aligned with program effects on hypertension. In this clinical trial follow-up at offspring ages 12 and 18, nurse-visited female offspring had lower rates of obesity and mothers of females had lower rates of hypertension than control-group counterparts. These findings suggest that risks for chronic disease among mothers of females and their female offspring who live in extreme poverty may be prevented with prenatal and infant and toddler home visitations by nurses. ClinicalTrials.gov Identifier: NCT00708695
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影响因子：
4.5
作者：
Bruckner, Tim A.;Catalano, Ralph;Ahern, Jennifer
通讯作者：
Ahern, Jennifer
影响因子：
3.8
作者：
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通讯作者：
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DOI：
10.1136/bmj.j3078
发表时间：
2017-07-12
期刊：
BMJ (Clinical research ed.)
影响因子：
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影响因子：
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