Comparing primiparous and multiparous mothers in a nurse home visiting prevention program.

BACKGROUND: An important yet overlooked feature of prominent prevention programs serving expectant mothers is the exclusion of women with children. This study examines mothers (n = 3,260) participating in a program without parity exclusion criteria, and compares demographic characteristics, risk status, service use, and child maltreatment outcomes.
METHODS: A longitudinal, prospective study comparing primiparous (n = 1,890) and multiparous (n = 1,370) mothers participating in a nurse home visiting program. Patient groups are compared using bivariate and multivariate methods.
RESULTS: Comparison by parity shows multiparous mothers had higher cumulative risk scores and individual risk factors related to maternal and child health, behavioral health, and violence exposure. Multiparous mothers were more likely to seek out services themselves and to initiate services later in the postnatal period. A significant trend exists among more children and greater caregiver stress, maternal depression, and child maltreatment. Multivariate models indicate infants of multiparous mothers have a higher risk (hazard ratio = 1.49) for later reports of child maltreatment.
CONCLUSIONS: As compared with primiparous mothers, multiparous mothers were at higher risk but had similar levels of service use. Programs limited to primiparous mothers are missing a critical opportunity for prevention. Programs serving multiparous mothers should incorporate strategies to directly address caregiver stress and postpartum depression.