Prenatal and Infancy Nurse Home Visiting Effects on Mothers: 18-Year Follow-Up of a Randomized Trial




David L. Olds, Harriet Kitzman, Elizabeth Anson, Joyce A. Smith, Michael D. Knudtson, Ted Miller, Robert Cole, Christian Hopfer, and Gabriella Conti

Brief Type

Journal Publication


  • Nurse-Family Partnership (NFP)


BACKGROUND: Prenatal and infancy home-visiting by nurses is promoted as a means of improving maternal life-course, but evidence of long-term effects is limited. We hypothesized that nurse­ visitation would lead to long-term reductions in public-benefit costs, maternal substance abuse and depression, and that cost-savings would be greater for mothers with initially higher psychological resources. METHODS: We conducted an 18-year follow-up of 618 out of 742 low-income, primarily African­ American mothers with no previous live births enrolled in an randomized clinical trial of prenatal and infancy home visiting by nurses. We compared nurse-visited and control-group women for public-benefit costs, rates of substance abuse and depression, and examined possible mediators of intervention effects. RESULTS: Nurse-visited women, compared with controls, incurred $17,310 less in public benefit costs (P = .03), an effect more pronounced for women with higher psychological resources ($28,847, P = .01). These savings compare with program costs of $12,578. There were no program effects on substance abuse or depression. Nurse-visited women were more likely to be married from child age 2 through 18 (19.2% vs 14.8%, P = .04), and those with higher psychological resources had 4.64 fewer cumulative years rearing subsequent children after the birth of the first child (P = .03). Pregnancy planning was a significant mediator of program effects on public benefit costs.
CONCLUSIONS: Through child age 18, the program reduced public-benefit costs, an effect more pronounced for mothers with higher psychological resources and mediated by subsequent pregnancy planning. There were no effects on maternal substance abuse and depression. (author abstract)

Data Collection Methods

  • Standardized assessment tools
  • State administrative record reviews



For More Information

Olds, D. L., Kitzman, H., Anson, E., Smith, J. A., Knudtson, M. D., Miller, T., Cole, R., Hopfer, C., & Conti, G. (2019). Prenatal and infancy nurse home visiting effects on mothers: 18-year follow-up of a randomized trial. Pediatrics, 144(6), e20183889. https://doi.org/10.1542/peds.2018-3889
Author Contact Information:
David L. Olds


  • Cost
  • Participant, Family, and Program Outcomes