Variation in Pregnancy Outcomes Following Statewide Implementation of a Prenatal Home Visitation Program




David M. Rubin, Amanda L. R. O'Reilly, Xianqun Luan, Dingwei Dai, Rissel Localio, and Cindy W. Christian

Brief Type

Journal Publication


  • Nurse-Family Partnership (NFP)


Objective: To examine, following statewide dissemination, the influence of an evidence-based home visitation program for first-time mothers on reductions of subsequent pregnancies across time and different locations.

Design: Retrospective cohort study.

Setting: Replication sites for the Nurse-Family Partnership (17 urban sites and 6 rural sites) across the Commonwealth of Pennsylvania between January 1, 2000, and December 31, 2007.

Participants: A total of 3844 Nurse-Family Partnership clients matched by propensity score to 10 938 local-area controls.

Main Exposure: Program enrollment.

Main Outcome Measurement: Time to second pregnancy resulting in a live birth within 2 years of the first infant's birth.

Results: There were no program effects on time to first pregnancy in the early years of the program (2000-2003), but clients whose first infants were born after 2003 had fewer second pregnancies compared with controls (hazard ratio = 0.87; 95% confidence interval, 0.80-0.96). This benefit occurred principally among mothers who were aged 18 years or younger (hazard ratio = 0.73, 95% confidence interval, 0.61-0.89) and was twice as strong among mothers aged 18 years or younger from rural locations (hazard ratio = 0.40; 95% confidence interval, 0.22-0.73) compared with those from urban locations (hazard ratio = 0.79; 95% confidence interval, 0.65-0.95).

Conclusions: Program effects on pregnancy planning emerged after an implementation period of 3 years in both urban and rural locations, but they were particularly strong in rural locations and among younger mothers. (author abstract)

Data Collection Methods

  • Program administrative record reviews



For More Information

Rubin, D.M., O'Reilly, A.L., Luan, X., Dai, D., Localio, R., Christian, C.W. (2011) Variation in pregnancy outcomes following statewide implementation of a prenatal home visitation program, Archives of Pediatric and Adolescent Medicin, 165(3), 196-204.
doi: 10.1001/archpediatrics.2010.221
Author contact information:
David Rubin


  • Participant Characteristics
  • Participant Recruitment, Retention, Engagement, and Dosage