Status of Birth Outcomes in Clients of the Nurse-Family Partnership.

Abstract

Background The Nurse-Family Partnership (NFP) is a national, evidence-based home visiting program currently serving over 30,000 first-time, low-income mothers. Prior to public implementation, three foundational randomized controlled trials demonstrated program effectiveness in achieving beneficial birth, child development, and maternal life-course outcomes. This study describes birth outcomes of contemporary NFP clients compared to a reference cohort, providing the first evidence of program effect on a nation-wide basis during scale-up. Methods A cohort of NFP clients beginning the program between 7/1/2007-6/30/2010 was compared to a reference cohort of first-time mothers from publicly available birth data (US Natality Data). Employing propensity score matching, NFP clients (n = 27,195) were each matched to three controls based on maternal age, race-ethnicity, smoking status, education, and marital status. Measures of low birth weight and preterm birth were compared between clients and controls using McNemar's Tests. Results Similar to the foundational trials, no significant difference in low birth weight was observed (NFP 9.4%, matched controls 9.6%, p = 0.20). However, in contrast to the foundational trials, the incidence of preterm births in NFP clients was significantly lower than in matched controls (8.7% vs. 12.3%, respectively; p < 0.0001). Discussion A recent review of NFP birth outcomes employing data pooling techniques (overcoming the statistical power limitations of the original foundational trials) has shown a trend toward a favorable program effect in the incidence of preterm births. The present study provides evidence of such an effect in a well-powered evaluation of recent clients during nation-wide scale-up, with these results meriting further confirmation.