Variation in pregnancy outcomes following statewide implementation of a prenatal home visitation program.

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 MEASURE 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.