@JAMA_current recently published initial results of a large South Carolina RCT of @NFP_nursefamily partnership — a nurse home visiting program for first-time mothers starting in pregnancy. Quick take: High-quality RCT finds no impact on adverse birth outcomes (but study is ongoing with additional results to come).

Program:

  • Nurse-Family Partnership (NFP) is an established nurse home visitation program for first-time mothers – mostly low-income and unmarried. The nurses visit the women 1-2 times/month during pregnancy & first 2 years of their child’s life, providing education, assessments, and goal-setting related to prenatal health, child health & development, and maternal life course.

Study Design:

  • The JAMA paper reports initial findings of a large, ongoing RCT of NFP in South Carolina, with a sample of 5,670 Medicaid-eligible pregnant women without previous children. Based on careful review, this is a well-conducted RCT (e.g., excellent baseline balance, negligible attrition for birth outcomes).

Findings:

  • The study found no discernible impact on the rate of adverse birth outcomes such as preterm birth or low birthweight (27% treatment vs 26% control - a difference that was not statistically significant). It also found no discernible impact on these outcomes for the subgroup of most vulnerable mothers.

Comment:

  • I think these findings, while disappointing, weren’t unexpected: Hopes NFP would improve birth outcomes were from less-rigorous quasi-experimental studies; earlier RCTs didn't suggest an effect. (Earlier RCTs did find positive effects on other child and maternal outcomes.)

  • The South Carolina RCT will report on the other 2 primary outcomes - birth spacing & child injury/abuse/neglect - in the future. Disclosure: @Arnold_Ventures (my former employer) is helping fund the longer-term study follow-up with @HarvardChanSPH @JPAL_NA researchers.

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