Unconditional Prenatal Income Supplement and Birth Outcomes

Canadian Medical Association Journal, 2007

S ocioeconomic factors can have profound effects on the health of individuals and populations, and the perinatal domain is particularly susceptible to such influences. The principal pathways by which socioeconomic status affects perinatal health include those that operate through lifestyle and behavioural factors: a large fraction of socioeconomic differences in adverse perinatal outcomes can be explained on the basis of factors such as maternal age, 1,2 smoking, 3,4 marital status, 5,6 alcohol consumption, 7 obesity, 8,9 residence (rural v. urban), 10 education, 7,11 weight gain, 12 early prenatal care, 13 prenatal class attendance, parity and breast-feeding. Differential access to good-quality obstetric services and neonatal care is another main reason for socioeconomic disparities in perinatal health. We have previously shown that the system of health care prevalent in Canada provides obstetric, neonatal and related health care services to women regardless of their socioeconomic status. 14 In fact, we found that rates of labour induction and cesarean delivery were higher among women from lower income families than among those from higher income families, after controlling for lifestyle and behavioural factors. 14 More generally, it has been shown that the introduction of universal access to essential health services in Canada in 1968 15 led to a decline in regional disparities in infant mortality, whereas such disparities have tended to increase globally. We carried out a population-based study to quantify the effects of socioeconomic factors (e.g., family income) on perinatal and infant outcomes in a setting where obstetric, neonatal and related health care services are widely available and provided with no out-of-pocket payments. Whereas other studies have examined this question previously using ecologic measures such as neighbourhood income, 17-19 we used highly reliable individual-level information on family income and related measures of socioeconomic status.

Journal of biosocial science, 2017

This study assessed the strength of the association between socioeconomic status (SES) and low birth weight (LBW) and preterm birth (PTB) in Southwestern Ontario. Utilizing perinatal and neonatal databases at the London Health Science Centre, maternal postal codes were entered into a Geographic Information System to determine home neighbourhoods. Neighbourhoods were defined by dissemination areas (DAs). Median household income for each DA was extracted from the latest Canadian Census and linked to each mother. All singleton infants born between February 2009 and February 2014 were included. Of 26,654 live singleton births, 6.4% were LBW and 9.7% were PTB. Top risk factors for LBW were: maternal amphetamine use, chronic hypertension and maternal marijuana use (OR respectively: 17.51, 3.18, 2.72); previously diagnosed diabetes, maternal narcotic use and insulin-controlled gestational diabetes predicted PTB (OR respectively: 17.95, 2.69, 2.42). Overall, SES had little impact on adverse...

Health Promotion and Chronic Disease Prevention in Canada, 2021

Introduction The Canada Prenatal Nutrition Program (CPNP) supports community organizations to provide maternal–infant health services for socially/economically vulnerable women. As part of our research program exploring opportunities to provide postnatal breastfeeding support through the CPNP, we investigated the sociodemographic and psychosocial characteristics of clients enrolled in a Toronto CPNP site and explored associations with participation. Methods Data were collected retrospectively from the charts of 339 women registered in one southwest Toronto CPNP site from 2013 to 2016. Multivariable regression analyses were used to assess associations between 10 maternal characteristics and three dimensions of prenatal program participation: initiation (gestational age at enrolment in weeks), intensity (number of times one-on-one supports were received) and duration (number of visits). Results The mean (SD) age of clients was 31 (5.7) years; 80% were born outside of Canada; 29% were ...

Asia-Pacific journal of public health / Asia-Pacific Academic Consortium for Public Health, 2015

Using a retrospective cohort study design, we report empirical evidence on the effect of parental socioeconomic status, primary care, and health care expenditure associated with preterm or low-birth-weight (PLBW) babies on their mortality (neonatal, postneonatal, and under-5 mortality) under a universal health care system. A total of 4668 singleton PLBW babies born in Taiwan between January 1 and December 31, 2001, are extracted from a population-based medical claims database for a follow-up of up to 5 years. Multivariate survival models suggest the positive effect of higher parental income is significant in neonatal period but diminishes in later stages. Consistent inverse relationship is observed between adequate antenatal care and the three outcomes: neonatal hazard ratio (HR) = 0.494, 95% confidence interval (CI) = 0.312 to 0.783; postneonatal HR = 0.282, 95% CI = 0.102 to 0.774; and under-5 HR = 0.575, 95% CI = 0.386 to 0.857. Primary care services uptake should be actively pro...

Health Promotion and Chronic Disease Prevention in Canada, 2016

Introduction In Quebec, women living on low income receive a number of additional prenatal care visits, determined by their area of residence, of both multi-component and food supplementation programs. We investigated whether increasing the number of visits reduces the odds of the main outcome of small for gestational age (SGA) birth (weight o 10th percentile on the Canadian scale). Methods In this ecological study, births were identified from Quebec’s registry of demographic events between 2006 and 2008 (n ¼ 156 404; 134 areas). Individual characteristics were extracted from the registry, and portraits of the general population were deduced from data on multi-component and food supplement interventions, the Canadian census and the Canadian Community Health Survey. Mothers without a high school diploma were eligible for the programs. Multilevel logistic regression models were fitted using generalized estimating equations to account for the correlation between individuals on the same...

Journal of obstetrics and gynaecology Canada : JOGC = Journal d'obstétrique et gynécologie du Canada : JOGC, 2007

Analysis of regional variations in use of prenatal care to identify individual-level and neighbourhood-level determinants of inadequate prenatal care among women giving birth in the province of Manitoba. Data were obtained from Manitoba Health administrative databases and the 1996 Canadian Census. An index of prenatal care use was calculated for each singleton live birth from 1991 to 2000 (N = 149,291). Births were geocoded into 498 geographic districts, and a spatial analysis was conducted, consisting of data visualization, spatial clustering, and data modelling using Poisson regression. We found wide variation in rates of inadequate prenatal care across geographic areas, ranging from 1.1% to 21.5%. Higher rates of inadequate care were found in the inner-city of Winnipeg and in northern Manitoba. After adjusting for individual characteristics, the highest rates of inadequate prenatal care were among women living in neighbourhoods with the lowest average family income, the highest p...

Journal of Population Economics, 2020

We study the acting mechanism of an early-life social safety net program and quantify its impact on child health outcomes at birth. We consider both the equity and efficiency implications of program impacts and provide a metric to compare such programs around the world. In particular, we estimate the impact of participation in Chile Crece Contigo (ChCC), Chile's flagship early-life health and social welfare program, using a difference-indifferences style model based on variation in program intensity and administrative birth data matched to social benefits usage. We find that this targeted social program had significant effects on birth weight (approximately 10 grams) and other early-life human capital measures. These benefits are largest among the most socially vulnerable groups but shift outcomes toward the middle of the distribution of health at birth. We show that the program is efficient when compared to other successful neonatal health programs around the world and find some evidence to suggest that maternal nutrition components and increased links to the social safety net are important action mechanisms. Keywords Public health • Neonatal health • Social security • Efficiency • Early-life investments JEL Classification H23 • O15 • I14 • H43 • O38 • H51

Journal of Obstetric, Gynecologic, and Neonatal Nursing, 2005

To examine personal costs (dollar costs and time spent) associated with prenatal care (PNC) attendance and outcomes (gestation length, PNC adequacy, and birth weight) for low-income, working women (N = 165).

Research Square (Research Square), 2023

Objectives: To determine the association between maternal health insurance type & birth outcomes [prematurity, small for gestational age (SGA), Term/Appropriate for gestational age NICU admission (Term/AGA-NICU) & composite birth outcomes (CBO)] accounting for social determinants of health. Design/Methods: Cross-sectional study of maternal surveys and birth certi cate data of singleton live births in NY born to mothers with Medicaid (M) or Private Insurance (PI). Results: 1015 mothers [M= 631, PI= 384) included. Individual birth outcomes did not differ between groups. Adjusting for social, demographic and clinical covariates, M mothers had similar odds of preterm birth, SGA, Term/AGA-NICU admission and CBO compared to PI. Conclusions: M mothers were as likely as PI mothers to deliver a preterm, SGA or a Term/AGA-NICU infant after controlling for social determinants of health. Despite more social adversity among enrollees, our study suggests NY Medicaid recipients have similar birth outcomes to privately insured, socially advantaged women.

Maternal and child health journal, 2003

This study examines whether four types of selection bias in estimates of the effectiveness of prenatal care utilization for improving birthweight occur in a population of economically disadvantaged women. We categorized adequacy of prenatal care use using the Adequacy of Prenatal Care Utilization Index (APNCU) and the Revised-GINDEX for 142,381 Medicaid recipients who gave birth to a live, singleton infant in Washington State (1994-1998). Multinomial logistic regression was used to model categories of adequacy of prenatal care use as functions of variables chosen to indicate high- or low-risk status. A series of linear regression models were estimated to quantify the magnitude and direction of any bias in the effects of prenatal care on birthweight that could be attributed to accounting for each risk covariate. Results were examined for patterns of risk, prenatal care use, and estimation bias equated with the four selection processes. We found modest evidence of adverse, favorable, ...

Economic Development and Cultural Change, 2013

Edición, diseño de cubierta, preprensa y prensa digital: Proceditor ltda.

Maternal and child health journal, 1997

To assess whether site of prenatal care influences the content of prenatal care for low-income women. Bivariate and logistic analyses of prenatal care content for low-income women provided at five different types of care sites (private offices, HMOs, publicly funded clinics, hospital clinics, and other sites of care), controlling for sociodemographic, behavioral, and maternal health characteristics. A sample of 3405 low-income women selected from a nationally representative sample of 9953 women surveyed by the National Maternal and Infant Health Survey, who had singleton live births in 1988, had some prenatal care (PNC), Medicaid participation, or a family income less than $12,000/year. Maternal report of seven initial PNC procedures (individually and combined), six areas of PNC advice (individually and combined), and participation in the Women Infant Children (WIC) nutrition program. The content of PNC provided for low-income women does not meet the recommendations of the U.S. Publ...

2019

S. (2012). The effect of CenteringPregnancy group prenatal care on preterm birth in a low-income population.

2020

This thesis investigated the connection between socioeconomic status, healthcare coverage, and birth outcomes. The research question that was posed specifically looked at twenty perinatal services that states covered under Medicaid to varying degrees to see their association, if any, with premature birth rates and low birthweight rates. State-level and Mississippi county-level data were compiled regarding preterm birth rates, low birthweight rates, presumptive eligibility adoption, and coverage of twenty different perinatal services. Using these data, the correlation between state Medicaid expansion status and birth outcomes was first calculated in order to determine if variation in birth outcomes was associated with expanded Medicaid coverage. After this, the relationship between birth outcomes and poverty was determined at both the state level and the Mississippi county level. The research found that poverty had a very positive correlation with high rates of poor birth outcomes and that state-level coverage was minimally correlated with birth outcomes. This study concluded by calling for further research into the Medicaid system, preventative care models for Medicaid, or systemic reform to the healthcare delivery system. AN EXAMINATION OF […] PERINATAL SERVICES AND BIRTH OUTCOMES iv ACKNOWLEDGEMENTS I would first like to thank Dr. John Green for all of the time and effort he has poured into my writing process throughout my undergraduate career. I would also like to thank my committee of readers, Dr. Lefmann and Dr. Dellinger for all of the editing advice and for being willing to take on another thesis defense. I would lastly like to thank my family for teaching me the importance of education and for supporting me wholeheartedly in my college endeavors.

Introduction: Healthcare coverage of pregnant women is associated with birth outcomes. Mothers whose pregnancies are insured by Medicaid are more likely to have a preterm and/or low birth weight infant compared with privately-insured mothers. Comparing birth outcomes for uninsured woman with Medicaid or privately-insured women is more complex as these women are disproportionately Hispanic and immigrant. Methods: Using new payment data from the birth certificate, percentages of births that are preterm and low birth weight will be compared among payment groups (private insurance, Medicaid, self-pay (uninsured)). Birth outcomes by payment source will also be examined in multivariate models which control for maternal sociodemographic and clinical risk factors. These models will also be stratified by prenatal care receipt (trimester in which care was initiated). Conclusions: These new birth certificate data will be an important, unique resource in examining outcomes by source of payment ...