Influence of Prenatal and Early Childhood Home-Visiting by Nurses on Development of Chronic Disease: 29-year Follow-Up of a Randomized Clinical Trial

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Project Summary This study consists of a 30-year follow-up of participants (N=742) in a randomized clinical trial of the Nurse-Family Partnership (NFP), a program of prenatal and infant/toddler home-visiting by nurses for low-income women with no previous live births, focusing on emergent chronic disease in mothers and first-born offspring. Previous assessments were conducted at registration, at the 36th week of gestation, and at the child’s 6th month and years 1, 2, 4.5, 6, 9, 12, and 18. NFP nurses are charged with improving: 1) pregnancy outcomes; 2) children’s health and development; and 3) women’s health and economic self-sufficiency. They do this by promoting women’s health behaviors, care of their child, planning subsequent pregnancies, completing their educations and finding work. Nurses explicitly promote women’s self-efficacy/mastery in managing challenges, foster informal social support (including involving fathers), and link families with health and human services. We propose to continue surveillance of health outcomes among mothers and offspring enrolled in this second NFP trial, which focused on very low-income, primarily African American (89%) women and their offspring. Eighty- five percent of the randomized mothers and offspring were assessed at the most recent 18-year follow-up. NFP effects have been found on a range of maternal outcomes through child age 18, including Pregnancy-Induced Hypertension (PIH), closely spaced subsequent pregnancies, marriage, sense of mastery, use of government benefits; and among mothers of females, reduced BP and self-reported kidney and heart problems. Nurse-visited offspring, through age 18, had lower rates of preventable mortality; among those born to mothers with limited coping capacity, lower rates of low birthweight and compromised cognitive functioning, receipt of Social Security Disability; and, among females, lower rates of obesity. At the 30-year follow-up, we expect to complete assessments on at least 80% of those randomized, 594 mothers and offspring. Findings from earlier follow-ups have led to our general hypothesis that, over the life-course, the intervention will lead to reductions in the emergence of cardio-vascular disease, chronic kidney disease, type-2 diabetes, and premature mortality among both mothers and their first-born offspring. We will a) conduct anthropometric assessments; b) draw blood to measure cardio-metabolic and immune-inflammatory factors; c) collect random urines to measure the microalbumin/creatinine ratio and cotinine; d) evaluate arterial stiffness using SphygmoCor and a standard peripheral BP instrument; e) conduct interviews to assess history of diagnoses, medications, menopause, hospitalizations, disability, sedentary and physical activity, sleep, diet, use of substances, depression, anxiety, sense of mastery, chronic pain, duration and quality of partnered relationships, education, work, and incarceration; f) review hospitalization records; and g) classify causes of death from the National Death Index (NDI). We will estimate Nurse-Visited (NV) - Control (C) differences in these outcome domains for both mothers and first-born offspring.