University College London, London, United Kingdom.
University of Rochester School of Nursing, Rochester, New York.
JAMA Netw Open. 2024 Jan 2;7(1):e2351752. doi: 10.1001/jamanetworkopen.2023.51752.
Individuals with low income may have heightened rates of obesity and hypertension.
To determine whether prenatal and infancy home visitation by nurses reduces maternal and offspring obesity and hypertension.
DESIGN, SETTING, AND PARTICIPANTS: This randomized clinical trial of prenatal and infancy nurse home visitation in a public health care system in Memphis, Tennessee, enrolled 742 women with no previous live births and at least 2 sociodemographic risk factors (unmarried, <12 years of education, unemployed) from June 1, 1990, through August 31, 1991. At registration during pregnancy, 727 mothers (98%) were unmarried, and 631 (85%) lived below the federal poverty level. At offspring ages 12 and 18 years, maternal and offspring obesity and hypertension were assessed by staff masked to treatment. The data analysis was performed from July 1, 2021, to October 31, 2023.
Women assigned to the control group received free transportation for prenatal care and child developmental screening and referral at child ages 6, 12, and 24 months. Women assigned to nurse visitation received transportation and screening plus prenatal and infant and toddler nurse home visits.
Obesity and hypertension among mothers and their offspring at child ages 12 and 18 years, although not hypothesized in the original trial design, were analyzed using post-double selection lasso method.
Of the 742 participants randomized (mean [SD] age, 18.1 [3.2] years), interviews were completed with 594 mothers and 578 offspring at child age 12 years and 618 mothers and 629 offspring at child age 18 years. Obesity was assessed for 576 offspring at age 12 years and 605 at age 18 years and for 563 and 598 mothers at child ages 12 and 18 years, respectively. Blood pressure was assessed for 568 offspring aged 12 years and 596 aged 18 years and 507 and 592 mothers at child ages 12 and 18 years, respectively. There were no overall treatment-control differences in offspring obesity or hypertension at ages 12 and 18 years combined, although nurse-visited female offspring, compared with controls, had a lower prevalence of obesity (adjusted relative risk [ARR], 0.449; 95% CI, 0.234-0.858; P = .003) and severe obesity (ARR, 0.185; 95% CI, 0.046-0.748; P < .001). There were reductions at ages 12 and 18 years combined for stage 1 and stage 2 hypertension for nurse-visited vs control group mothers, with differences limited to mothers of females (stage 1: ARR, 0.613 [95% CI, 0.440-0.855; P = .001]; stage 2: ARR, 0.217 [95% CI, 0.081-0.582; P < .001]). For both obesity and hypertension outcomes, there was no intervention effect among male offspring or the mothers of males. Self-reported maternal health aligned with program effects on hypertension.
In this clinical trial follow-up at offspring ages 12 and 18, nurse-visited female offspring had lower rates of obesity and mothers of females had lower rates of hypertension than control-group counterparts. These findings suggest that risks for chronic disease among mothers of females and their female offspring who live in extreme poverty may be prevented with prenatal and infant and toddler home visitations by nurses.
ClinicalTrials.gov Identifier: NCT00708695.
收入较低的个体可能肥胖和高血压的发病率更高。
确定护士对孕妇和婴儿的家访是否可以降低母婴肥胖和高血压的发病率。
设计、设置和参与者：这项在田纳西州孟菲斯市公共医疗保健系统中进行的护士对孕妇和婴儿家访的随机临床试验，共纳入 742 名没有生育史且至少有 2 个社会人口学风险因素（未婚、受教育程度低于 12 年、失业）的女性。1990 年 6 月 1 日至 1991 年 8 月 31 日期间，在怀孕登记时，727 名母亲（98%）未婚，631 名母亲（85%）生活在联邦贫困线以下。在孩子 12 岁和 18 岁时，工作人员对母亲和子女的肥胖和高血压情况进行了评估，评估人员对治疗情况不知情。数据分析于 2021 年 7 月 1 日至 2023 年 10 月 31 日进行。
对照组的女性在接受免费产前护理和儿童发育筛查和转介的同时，还获得了儿童 6、12 和 24 个月时的交通服务。接受护士家访的女性除了交通和筛查服务外，还接受了产前、婴儿和幼儿的家访。
尽管在最初的试验设计中没有假设，但使用事后双重选择套索法分析了孩子 12 岁和 18 岁时母亲及其子女的肥胖和高血压情况。
在 742 名随机分组的参与者中（平均[标准差]年龄为 18.1[3.2]岁），在孩子 12 岁时完成了 594 名母亲和 578 名子女的访谈，在孩子 18 岁时完成了 618 名母亲和 629 名子女的访谈。在孩子 12 岁时评估了 576 名子女的肥胖情况，在孩子 18 岁时评估了 605 名子女的肥胖情况，分别评估了 563 名和 598 名母亲的肥胖情况。在孩子 12 岁时评估了 568 名子女的血压情况，在孩子 18 岁时评估了 596 名子女的血压情况，分别评估了 507 名和 592 名母亲的血压情况。总体而言，无论是否接受治疗，子女在 12 岁和 18 岁时的肥胖或高血压发生率没有差异，但与对照组相比，接受护士家访的女性子女肥胖发生率较低（调整后的相对风险[ARR]，0.449；95%置信区间[CI]，0.234-0.858；P=0.003），严重肥胖发生率也较低（ARR，0.185；95%CI，0.046-0.748；P<0.001）。在 12 岁和 18 岁时，与对照组相比，接受护士家访的母亲组的 1 期和 2 期高血压的发生率均有所降低，这种差异仅限于女性母亲（1 期：ARR，0.613；95%CI，0.440-0.855；P=0.001；2 期：ARR，0.217；95%CI，0.081-0.582；P<0.001）。对于肥胖和高血压的结局，男性子女或男性子女的母亲均没有干预效果。母亲自我报告的健康状况与高血压的干预效果一致。
在这项临床试验的随访中，在孩子 12 岁和 18 岁时，接受护士家访的女性子女肥胖率较低，女性母亲的高血压发病率较低。这些发现表明，对于生活在极端贫困中的女性及其女性后代的母亲，可能可以通过护士对孕妇和婴儿的家访来预防慢性疾病的风险。
ClinicalTrials.gov 标识符：NCT00708695。
