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

项目摘要 本研究包括对一项随机临床试验的参与者（N = 742）进行30年随访， 护士-家庭伙伴关系，这是一项由护士为低收入家庭进行产前和婴幼儿家访的方案。 以前没有活产的妇女，重点是母亲和第一个出生的子女中出现的慢性疾病。 之前的评估在登记时、妊娠第36周和婴儿第6个月时进行 以及第1、2、4.5、6、9、12和18年。NFP护士负责改善：1）妊娠结局; 2） 儿童的健康和发展; 3）妇女的健康和经济自给自足。他们通过 促进妇女的健康行为，照顾她们的孩子，计划以后的怀孕，完成她们的 教育和找工作。护士明确促进妇女在管理挑战方面的自我效能/掌握， 促进非正式的社会支持（包括让父亲参与），并将家庭与保健和人类服务联系起来。我们 建议继续监测参加第二次国家计划生育方案的母亲和子女的健康结果 这项试验主要针对非常低收入的非裔美国人（89%）妇女及其子女。八十- 在最近的18年随访中，对5%的随机母亲和子女进行了评估。 NFP对18岁以下儿童的一系列孕产妇结局产生了影响，包括 妊娠高血压综合征（PIH）、间隔较近的后续妊娠、婚姻、掌控感， 使用政府福利;在女性的母亲中，血压降低，自我报告的肾脏和心脏 问题在18岁之前，有护士探视的后代的可预防死亡率较低;在那些出生于 对于应对能力有限、低出生体重率较低和认知功能受损的母亲， 社会保障残疾;女性肥胖率较低。 在30年的随访中，我们预计至少有80%的随机化患者完成评估，594 母亲和孩子早期随访的结果导致了我们的一般假设，即， 生命过程中，干预将导致减少心血管疾病的出现，慢性 肾脏疾病、2型糖尿病和母亲及其第一个孩子的过早死亡率 后代我们将a）进行人体测量评估; B）抽血测量心脏代谢， c）收集随机尿液以测量微量白蛋白/肌酸酐比率，以及 可替宁; d）使用SphygmoCor和标准外周BP仪器评估动脉硬度; e）进行 访谈以评估诊断史、药物治疗史、绝经史、住院史、残疾史、久坐史和 体力活动、睡眠、饮食、物质使用、抑郁、焦虑、掌控感、慢性疼痛、持续时间 和合作关系的质量，教育，工作，和监禁; f）审查住院记录;和 g）根据国家死亡指数（NDI）对死亡原因进行分类。我们将估计护士访视（NV）-对照 (C)母亲和第一胎子女在这些结果领域的差异。

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.