Objective: Pregnancy-associated injury-related deaths due to overdose, homicide and suicide continue increasing in the U.S. However, limited studies address their precursors perinatal depression, substance use (SU), and self-harm ideation (SHI). We performed secondary data analyses of a three-wave longitudinal randomized controlled trial of the Nurse-Family Partnership (NFP) program.

Methods: In Oregon, 238 low-income, first-time pregnant mothers were randomized to a standard or augmented program where trained nurses integrated the Within My Reach curriculum and intimate partner violence screening and referral with the NFP workflow one-on-one at home visits. At pregnancy, 1-year, and 2-year follow-ups, research assistants interviewed mothers with the Edinburgh Postnatal Depression Scale (including an SHI item), Alcohol Use Disorder Identification Test, and Drug Abuse Screening Test. Multilevel models and generalized estimating equations with the wave-intervention interactions were performed, adjusting for race/ethnicity, age, education level, and nativity status.

Results: Depressive symptoms (25%), SU (36%), and SHI (8%) were common. Compared with the standard program, the augmented program indicated stable partner relationships (66% vs. 50%, p=0.01) and reduced depressive symptoms at the 1-year follow-up (p=0.02) but did not reduce depressive symptoms, SHI, or SU over the two years.

Conclusions: These results can inform the design of large pragmatic transdisciplinary studies regarding mechanisms of change and integrating strategies (e.g., engage fathers, include co-parenting, and target SHI and SU). Building a consortium with experts, providers, payers, and families to implement a type 2 hybrid effectiveness-implementation pilot trial of injury-related maternal early warning systems might address injury-related disparities and promote safe motherhood.