Influence of Prenatal and Early Childhood Home-Visiting by Nurses on Development of Chronic Disease: 29-year Follow-Up of a Randomized Clinical Trial
|Dates:||6/22/2020 - 5/31/2024|
National Heart Lung and Blood institute (NHLBI)
|Role:||Susan Groth, PhD, WHNP-BC, FAANP : Site PI|
|Principal Investigator:||David L Olds; Dana Dabelea; Stephen R Daniels|
This study is a 29-year follow-up of participants in a randomized clinical trial of the Memphis New Mothers’ Study, the second Nurse-Family Partnership (NFP) trial, currently focusing on emergent chronic disease in mothers and first-born offspring. NFP is a program of prenatal and infant/toddler home-visiting by nurses for low-income women with no previous live births, 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. This project is continued surveillance of health outcomes among mothers and offspring enrolled in the 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 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. 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 mothers and their first-born offspring. We are conducting a variety of assessments including: a) anthropometric assessments; b) cardiometabolic and immune-inflammatory factors; c) microalbumin/creatinine ratio; d) BP and arterial stiffness; e) interviews to assess health history and behaviors, depression, anxiety, sense of mastery, duration and quality of partnered relationships, education, work, and incarceration. We will estimate Nurse-Visited–Control differences in these outcome domains for both mothers and first-born offspring.