Prevention of Intellectual Impairment in Children of Women Who Smoke Cigarettes During Pregnancy

The acknowledgement section of the following two articles should have included the statement listed below: Prevention of Intellectual Impairment in Children of Women Who Smoke Cigarettes During Pregnancy. Pediatrics. 1994;93:228-233. We thank Robert Chamberlin for serving as co-investigator on the original trial; John Shannon for his administrative support of the work; and Elizabeth Chilson, Diane Farr, Georgianna McGrady, Jacqueline Roberts, and Lyn Scazafabo for their work with the families enrolled in the program.</jats:p

Intellectual Impairment in Children of Women Who Smoke Cigarettes During Pregnancy

Objective. To examine the relationship between maternal cigarette smoking during pregnancy and children's intellectual functioning during the first 4 years of life. Design. Prospective follow-up of participants in a randomized trial of pregnancy and infancy nurse home visitation. Setting. Semirural community in Upstate New York. Participants. 400 families in which the mothers registered before the 30th week of pregnancy and had no previous live births. Eighty-five percent of the mothers were either teenagers (&amp;lt;19 years at registration), unmarried, or poor. Analysis limited to whites who comprised 89% of the sample. Main results. Children in the comparison group whose mothers smoked 10 or more cigarettes per day during pregnancy had Stanford-Binet scores at 3 and 4 years of age that were 4.35 (95% CI: 0.02, 8.68) points lower (after controlling for a wide range of variables) than their counterparts whose mothers did not smoke during pregnancy. Conclusions. The results of this study add to the increasingly consistent evidence that maternal cigarette smoking during pregnancy poses a unique risk for neurodevelopmental impairment among children and provide an additional reason for pregnant women not to smoke cigarettes.</jats:p

Intellectual Impairment in Children of Women Who Smoke Cigarettes During Pregnancy

The acknowledgement section of the following two articles should have included the statement listed below: Intellectual Impairment in Children of Women Who Smoke Cigarettes During Pregnancy. Pediatrics. 1994;93:221-227. We thank Robert Chamberlin for serving as co-investigator on the original trial; John Shannon for his administrative support of the work; and Elizabeth Chilson, Diane Farr, Georgianna McGrady, Jacqueline Roberts, and Lyn Scazafabo for their work with the families enrolled in the program.</jats:p

Prevention of Intellectual Impairment in Children of Women Who Smoke Cigarettes During Pregnancy

Objective. To analyze the influence of a comprehensive program of nurse home visitation on the intellectual functioning of children born to women who smoked cigarettes during pregnancy. Design. Randomized clinical trial. Treatment 1: sensory and developmental screening at ages 1 and 2 years; treatment 2: screening plus free transportation for prenatal and well-child care; treatment 3: screening, transportation, plus prenatal home visitation; treatment 4: screening, transportation, prenatal home visitation, plus postnatal home visitation through the children's second birthdays. Setting. Semirural community in Upstate New York. Participants. 400 families in which the mothers registered before the 30th week of pregnancy and had no previous live births. Eighty-five percent of the mothers were either teenagers, unmarried, or poor. Analysis was limited to whites, who constituted 89% of sample. Intervention. Nurse home visitation during pregnancy (treatments 3 and 4) or during pregnancy and the first 2 years of the child's life (treatment 4). During pregnancy, the nurses helped women improve their health-related behaviors, informal social support, and linkage with needed community services. Main findings. Children born to women who smoked 10 or more cigarettes per day at registration during pregnancy and who were assigned to treatments 3 and 4 had IQs (averaging across the 3rd and 4th years of life) that were 4.86 (95% CI: 0.47, 9.26) points higher after adjustment for covariates than did children born to women who smoked 10+ cigarettes per day and who were assigned to treatments 1 and 2. The positive influence of the home-visiting program on reducing the harmful effect of smoking appears to be due to prenatal visitation. Conclusion. Comprehensive prenatal home-visitation services can offset the impairment in intellectual functioning associated with substantial maternal smoking during pregnancy.</jats:p

Improving the Delivery of Prenatal Care and Outcomes of Pregnancy: A Randomized Trial of Nurse Home Visitation

We evaluated a comprehensive program of prenatal and postpartum nurse home visitation. The program was designed to prevent a wide range of health and developmental problems in children born to primiparous women who were either teenagers, unmarried, or of low socioeconomic status. During pregnancy, women who were visited by nurses, compared with women randomly assigned to comparison groups, became aware of more community services; attended childbirth classes more frequently; made more extensive use of the nutritional supplementation program for women, infants, and children; made greater dietary improvements; reported that their babies' fathers became more interested in their pregnancies; were accompanied to the hospital by a support person during labor more frequently; reported talking more frequently to family members, friends, and service providers about their pregnancies and personal problems; and had fewer kidney infections. Positive effects of the program on birth weight and length of gestation were present for the offspring of young adolescents (&amp;lt;17 years of age) and smokers. In contrast to their comparison-group counterparts, young adolescents who were visited by nurses gave birth to newborns who were an average of 395 g heavier, and women who smoked and were visited by nurses exhibited a 75% reduction in the incidence of preterm delivery. (P ≤ .05 for all findings.</jats:p

Preventing Child Abuse and Neglect: A Randomized Trial of Nurse Home Visitation

A program of prenatal and infancy home visitation by nurses was tested as a method of preventing a wide range of health and developmental problems in children born to primiparas who were either teenagers, unmarried, or of low socioeconomic status. Among the women at highest risk for care-giving dysfunction, those who were visited by a nurse had fewer instances of verified child abuse and neglect during the first 2 years of their children's lives (P = .07); they were observed in their homes to restrict and punish their children less frequently, and they provided more appropriate play materials; their babies were seen in the emergency room less frequently during the first year of life. During the second year of life, the babies of all nurse-visited women, regardless of the families' risk status, were seen in the emergency room fewer times, and they were seen by physicians less frequently for accidents and poisonings than comparison group babies (P ≤ .05 for all findings, except where indicated.) Treatment differences for child abuse and neglect and emergency room visits were more significant among women who had a lower sense of control over their lives.</jats:p