1. Beal, Judy DNSc, PNP, RN
  2. Heaman, Maureen PhD, RN

Article Content

Carabin, H., Cowan, L. D., Beebe, L. A., Skaggs, V. J., Thompson, D., & Agbangla, C. (2005).Paediatric and Perinatal Epidemiology, 19, 194-205.


This study examines the effect of participation in Children First, a nurse home visitation program for first-time mothers implemented statewide in Oklahoma. The program targets young pregnant women of low socioeconomic status. The investigators compared the risk of preterm birth, low birthweight, and infant mortality in first-born children of participants (n = 8598) and a comparison group of nonparticipating mothers (n = 55,737), using birth certificates, between 1998 and 2001. Among single women without pregnancy risk factors, the frequencies of all adverse outcomes were markedly reduced in Children First participants compared with nonparticipating mothers. These risk reductions were not observed among single women with pregnancy risk factors or among married mothers either with or without pregnancy risk factors.


Because this study was not a randomized controlled trial, the possibility exists that factors other than participation in the program could explain the observed differences in pregnancy outcomes. The Children First program did not appear to be effective in reducing adverse outcomes among women with pregnancy risk factors, suggesting that home visiting programs need to carefully target their service groups and improve interventions for women with known risk factors. Nonetheless, the fact that participation in Children First was associated with a lower incidence of preterm and very preterm births and infant mortality among single women without pregnancy risk factors is encouraging. In particular, preventing preterm birth is challenging because of its complex, multifactorial nature and the fact that its etiology is poorly understood. Unfortunately, these investigators did not have the data necessary to identify which components of Children First might be responsible for producing the observed effects. They recommend that future analyses of home visiting programs should focus on isolating the program components that are specifically associated with reducing the risk of adverse perinatal outcomes such as preterm birth.


Comment by Maureen Heaman