One Size Does Not Fit All: An Examination of Low Birthweight Disparities Among a Diverse Set of Racial/Ethnic Groups

To examine disparities in low birthweight using a diverse set of racial/ethnic categories and a nationally representative sample. This research explored the degree to which sociodemographic characteristics, health care access, maternal health status, and health behaviors influence birthweight disparities among seven racial/ethnic groups. Binary logistic regression models were estimated using a nationally representative sample of singleton, normal for gestational age births from 2001 using the ECLS-B, which has an approximate sample size of 7,800 infants. The multiple variable models examine disparities in low birthweight (LBW) for seven racial/ethnic groups, including non-Hispanic white, non-Hispanic black, U.S.-born Mexican-origin Hispanic, foreign-born Mexican-origin Hispanic, other Hispanic, Native American, and Asian mothers. Race-stratified logistic regression models were also examined. In the full sample models, only non-Hispanic black mothers have a LBW disadvantage compared to non-Hispanic white mothers. Maternal WIC usage was protective against LBW in the full models. No prenatal care and adequate plus prenatal care increase the odds of LBW. In the race-stratified models, prenatal care adequacy and high maternal health risks are the only variables that influence LBW for all racial/ethnic groups. The race-stratified models highlight the different mechanism important across the racial/ethnic groups in determining LBW. Differences in the distribution of maternal sociodemographic, health care access, health status, and behavior characteristics by race/ethnicity demonstrate that a single empirical framework may distort associations with LBW for certain racial and ethnic groups. More attention must be given to the specific mechanisms linking maternal risk factors to poor birth outcomes for specific racial/ethnic groups.     

Racial and Ethnic Disparities in Low Birthweight Among Urban Unmarried Mothers

Objectives We examined racial and ethnic disparities in low birthweight (LBW) among unmarried mothers and the extent to which demographic, economic, psychosocial, health, health care, and behavioral factors explain those disparities. Methods Using a sample of 2,412 non-marital births from a national urban birth cohort study, we estimated multiple logistic regression models to examine disparities in LBW between non-Hispanic white (NHW), non-Hispanic black (NHB), U.S.-born Mexican-origin (USMO), and foreign-born Mexican-origin (FBMO) mothers. Results NHW mothers were almost as likely as NHB mothers to have LBW infants. USMO mothers had 60% lower odds and FBMO mothers had 57% lower odds than NHW mothers of having LBW infants. FBMO mothers had no advantage compared to USMO mothers. Controlling for prenatal health and behaviors substantially reduced the LBW advantages for USMO and FBMO mothers. The odds of LBW for NHB mothers relative to NHW mothers increased with the addition of the same covariates. Conclusions Racial and ethnic disparities in LBW among unmarried mothers—an economically disadvantaged population—do not mirror those in the general population. Prenatal health and behaviors are strongly associated with LBW in this group and explain a sizable portion of the Mexican-origin advantage. The lack of a significant black-white disparity in this group suggests that poverty plays an important role in shaping racial disparities in the general population. The finding that controlling for prenatal health and behaviors widens rather than narrows the racial disparity suggests that efforts to ameliorate black-white disparities in LBW should focus on social and health risks throughout the life course.     

Prenatal care and infant birth outcomes among Medicaid recipients

Infant morbidity due to low birth weight and preterm births results in emotional suffering and significant direct and indirect costs. African American infants continue to have worse birth outcomes than white infants. This study examines relationships between newborn hospital costs, maternal risk factors, and prenatal care in Medicaid recipients in an impoverished rural county in South Carolina. Medicaid African American mothers gave birth to fewer preterm infants than did non-Medicaid African American mothers. No differences in the rates of preterm infants were noted between white and African American mothers in the Medicaid group. Access to Medicaid services may have contributed to this reduction in disparities due to race. Early initiation of prenatal care compared with later initiation did not improve birth outcomes. Infants born to mothers who initiated prenatal care early had increased morbidity with increased utilization of hospital services, suggesting that high-risk mothers are entering prenatal care earlier.     

Community Health Centers and racial/ethnic disparities in healthy life.

This study examined disparities in health status among individuals of different racial and ethnic groups cared for by the nation's community health centers (CHCs) and compared these results with the findings for individuals using non-CHC sites as their usual source of care. The sample consisted of CHC users from the 1994 CHC User Survey and non-CHC users from the 1994 National Health Interview Survey. Bivariate comparisons were made between individuals' race/ethnicity and their experience of healthy life, an integrated measure that incorporates both activity limitation and self-perceived health status. Multiple regressions were followed to examine the independent association of race/ethnicity with healthy life experience for both CHC and non-CHC users while controlling for sociodemographic correlates of health. Among CHC users, racial and ethnic minorities did not have worse health than whites, but among non-CHC users there were significant racial and ethnic disparities: whites experienced significantly healthier life than both blacks and non-white Hispanics. These findings persisted after controlling for sociodemographic correlates of health. The results indicate that while racial/ethnic disparities in health persist nationally, these disparities do not exist within CHCs, safety-net providers with an explicit mission to serve vulnerable populations.     

Obstetric Complications in Women with Diagnosed Mental Illness: The Relative Success of California's County Mental Health System

Objective. To examine disparities in serious obstetric complications and quality of obstetric care during labor and delivery for women with and without mental illness.
Data Source. Linked California hospital discharge (2000–2001), birth, fetal death, and county mental health system (CMHS) records.
Study Design. This population-based, cross-sectional study of 915,568 deliveries in California, calculated adjusted odds ratios (AORs) for obstetric complication rates for women with a mental illness diagnosis (treated and not treated in the CMHS) compared with women with no mental illness diagnosis, controlling for sociodemographic, delivery hospital type, and clinical factors.
Results. Compared with deliveries in the general non–mentally ill population, deliveries to women with mental illness stand a higher adjusted risk of obstetric complication: AOR=1.32 (95 percent confidence interval [CI]=1.25, 1.39) for women treated in the CMHS and AOR=1.72 (95 percent CI=1.66, 1.79) for women not treated in the CMHS. Mentally ill women treated in the CMHS are at lower risk than non-CMHS mentally ill women of experiencing conditions associated with suboptimal intrapartum care (postpartum hemorrhage, major puerperal infections) and inadequate prenatal care (acute pyelonephritis).
Conclusion. Since mental disorders during pregnancy adversely affect mothers and their infants, care of the mentally ill pregnant woman by mental health and primary care providers warrants special attention.     

Changing Trends in Low Birth Weight Rates Among Non-Hispanic Black Infants in the United States, 1991–2004

We examined trends in low birth weight (LBW, <2,500 g) rates among US singleton non-Hispanic black infants between 1991 and 2004. We conducted Joinpoint regression analyses, using birth certificate data, to describe trends in LBW, moderately LBW (MLBW, 1,500–2,499 g), and very LBW (VLBW, <1,500 g) rates. We then conducted cross-sectional and binomial regression analyses to relate these trends to changes in maternal or obstetric factors. Non-Hispanic black LBW rates declined −7.35% between 1991 and 2001 and then increased +4.23% through 2004. The LBW trends were not uniform across birth weight subcategories. Among MLBW births, the 1991–2001 decease was −10.20%; the 2001–2004 increase was +5.61%. VLBW did not follow this pattern, increasing +3.84% between 1991 and 1999 and then remaining relatively stable through 2004. In adjusted models, the 1991–2001 MLBW rate decrease was associated with changes in first-trimester prenatal care, cigarette smoking, education levels, maternal foreign-born status, and pregnancy weight gain. The 2001–2004 MLBW rate increase was independent of changes in observed maternal demographic characteristics, prenatal care, and obstetric variables. Between 1991 and 2001, progress occurred in reducing MLBW rates among non-Hispanic black infants. This progress was not maintained between 2001 and 2004 nor did it occur for VLBW infants between 1991 and 2004. Observed population changes in maternal socio-demographic and health-related factors were associated with the 1991–2001 decrease, suggesting multiple risk factors need to be simultaneously addressed to reduce non-Hispanic black LBW rates.     

Prenatal and Postpartum Care Disparities in a Large Medicaid Program

Objectives Pennsylvania’s maternal mortality, infant mortality, and preterm birth rates rank 24th, 35th, and 25th in the country, and are higher among racial and ethnic minorities. Provision of prenatal and postpartum care represents one way to improve these outcomes. We assessed the extent of disparities in the provision and timeliness of prenatal and postpartum care for women enrolled in Pennsylvania Medicaid. Methods We performed a cross-sectional evaluation of representative samples of women who delivered live births from November 2011 to 2015. Our outcomes were three binary effectiveness-of-care measures: prenatal care timeliness, frequency of prenatal care, and postpartum care timeliness. Pennsylvania’s Managed Care Organizations (MCOs) were required to submit these outcomes to the state after reviewing administrative and medical records through a standardized, validated sampling process. We assessed for differences in outcomes by race, ethnicity, region, year, and MCO using logistic regression. Results We analyzed data for 12,228 women who were 49% White, 31% Black/African American, 4% Asian, and 15% Hispanic/Latina. Compared to Black/African American women, white and Asian women had higher odds of prenatal and postpartum care. Hispanic/Latina women had higher frequency of prenatal care than non-Hispanic women. Pennsylvania’s Southeast had lower prenatal care and Northwest had lower postpartum care than other regions. Prenatal care significantly decreased in 2014 and increased in 2015. We observed differences between MCOs, and as MCO performance diminished, racial disparities within each plan widened. We explored hypotheses for observed disparities in secondary analyses. Conclusions for Practice Our data demonstrate that interventions should address disparities by race, region, and MCO in equity-promoting measures.     

Prenatal drug use and the production of infant health

We estimate the effect of illicit drug use during pregnancy on two measures of poor infant health: low birth weight and abnormal infant health conditions. We use data from a national longitudinal study of urban parents that includes postpartum interviews with mothers, hospital medical record data on the mothers and their newborns, and information about the neighborhood in which the mother resides. We address the potential endogeneity of prenatal drug use. Depending on how prenatal drug use is measured, we find that it increases low birth weight by 4-6 percentage points and that it increases the likelihood of an abnormal infant health condition by 7-12 percentage points.     

Explaining ethnic disparities in preterm birth in Argentina and Ecuador

Little is understood about racial/ethnic disparities in infant health in South America. We quantified the extent to which the disparity in preterm birth (PTB; <37 gestational weeks) rate between infants of Native only ancestry and those of European only ancestry in Argentina and Ecuador are explained by household socio-economic, demographic, healthcare use, and geographic location indicators. The samples included 5199 infants born between 2000 and 2011 from Argentina and 1579 infants born between 2001 and 2011 from Ecuador. An Oaxaca-Blinder type decomposition model adapted to binary outcomes was estimated to explain the disparity in PTB risk across groups of variables and specific variables. Maternal use of prenatal care services significantly explained the PTB disparity, by nearly 57% and 30% in Argentina and Ecuador, respectively. Household socio-economic status explained an additional 26% of the PTB disparity in Argentina. Differences in maternal use of prenatal care may partly explain ethnic disparities in PTB in Argentina and Ecuador. Improving access to prenatal care may reduce ethnic disparities in PTB risk in these countries.     

Exploring Birth Outcome Disparities and the Impact of Prenatal Care Utilization Among North Carolina Teen Mothers

BackgroundThis study investigated the role of prenatal care utilization in explaining disparities in birth outcomes between African-American and White teen mothers in North Carolina.MethodsThis cross-sectional study analyzed birth record data for African-American and White teen mothers provided by the North Carolina State Center of Health Statistics for 2009 (n = 10,515). Hierarchical moderated multiple regression models were completed to explore associations between racial status, prenatal care utilization, and birth outcome disparities amid multiple demographic and medical risk factors.FindingsRacial status as African American was identified as a significant predictor for lower birth weight and gestational age in each regression model when accounting for other demographic variables, medical risk factors, and prenatal care utilization. Results illuminate significant associations between higher prenatal care utilization levels and higher infant birth weight and gestational age for the overall teen population. However, these results did not identify protective effects in reducing racial disparities in birth weight or gestational age.ConclusionGiven these results, a more in-depth exploration of prenatal care client assessment, education, and alternative prenatal care models is warranted to identify strategies for reducing birth outcome disparities between these populations. These findings also suggest the need for further examination of other potential social and economic factors that explain racial disparities in birth outcomes between African-American and White teen populations.     

PMD9 Evaluation of a Pathway for Providing Pharmaceutical Care

This study is the first to examine the determination of birth outcomes, employing individual data at the national level in the U.S. The data source is from the 1987 U.S. linked birth/infant death certificates. Our analytical framework is to estimate the infant health production function from a behavioral model in which health inputs are themselves choices. We place major emphasis on the instrumental variables method of estimation to correct for the endogeneity bias. The effects of endogenous inputs, such as prenatal care, maternal age, and fertility, on birth weight are investigated. We specially focus on the analysis of the effect of prenatal care on birth weight, controlling for endogeneity of prenatal care, maternal age, and fertility.
We find that OLS underestimates the gains to prenatal care by a factor of 9.4 for blacks, about 3.1 for whites, and 4.8 for the pooled blacks and whites sample. Black mothers who seek prenatal care one month earlier give birth to babies 124 g more in birth weight, while for white mothers the corresponding number is about 99 g. The policy implications for this study are straightforward. The benefits for public prenatal care programs appear substantial, especially for blacks. Moreover, costeffective approaches to improving birth outcomes through the expanded utilization of prenatal care will motivate women who otherwise would receive late or no care to begin care in the early trimester.     

围产保健与儿童保健监测的方法与应用

目的：研究最佳围产保健与儿童保健的监测方法与应用,为母婴与儿童提供及时,系统的保健服务。方法：新婚妇女在婚前检查时建立围产保健册、随后开始月经监测,确定早孕后,定期作产前复查等监测。直到产后42d为止;新生儿应在出生42d内建立儿童保健册,然后根据监测对象的年龄 常规体检的原则,完成相应年龄段的询问,体检、实验室检查与评价。监测全程均有质量控制措施,所有的监测结果均录入计算机。实现计算机化管理。结果：该监测系统已经在我国的32个县（市）中实施,覆盖地区的总人口超过2千万,从1993年至,围产保健监测系统已成地连续运转了8年,儿童保健监测系统已成功地连续运转了4年。结论：该围产保健与儿童保健监监适合我国,国情,运转顺利,对促进和提高当地的围产保健与儿童保健工作水平,提高我国人口素质将发挥重要作用。     

Good outcome of teenage pregnancies in high-quality maternity care

BACKGROUND: Teenage pregnancies have been associated with fetal growth restriction, low birth weight, preterm birth and neonatal mortality. These could be due to biological immaturity, lifestyle factors or inadequate attendance to maternity care. The objective of this study was to assess the relationship between young age of the mother and pregnancy risk factors and adverse pregnancy outcome in conditions of high-quality maternity care used by almost the entire pregnant population. METHODS: We analysed a population-based database of 26,967 singleton pregnancies during 1989-2001. Only 185 of these mothers were under 18 years old. Data were collected using a self-administered questionnaire at 20 weeks of pregnancy and clinical records of pregnancy, delivery and newborn child. The information covered maternal risk factors, pregnancy characteristics and obstetric outcomes. Odds ratios (ORs) for adverse pregnancy outcomes in teenage compared with older mothers were obtained from multiple logistic regression models. RESULTS: Teenage mothers smoked, were unemployed and had anaemia or chorioamnionitis more often than older mothers. On the other hand, they were overweight and had maternal diabetes less often than adults. Teenage mothers had as many instrumented deliveries (OR 0.70; 95% confidence interval 0.39-1.27) but fewer Caesarean sections (0.62; 0.39-0.97) than adults. We found no evidence for increased risk of preterm delivery, fetal growth restriction, low birth weight, or fetal or perinatal death in teenage mothers. CONCLUSIONS: These results suggest that increased risks for adverse pregnancy outcomes in teenage pregnancies can most probably be overcome by means of high-quality maternity care with complete coverage.     

The dietary beliefs and attitudes of women who have had a low-birthweight baby: a retrospective preconception study

Background and aims A poor diet in the preconception period is believed to lead to an increased chance of the subsequent baby being born with a low birth weight (LBW) and in particular symmetrically growth retarded (where both the head and the body are proportionately small). The aim of this study was to determine whether a woman's diet, social background and attitude towards diet has any bearing on the incidence of LBW.
Method A questionnaire was administered to 31 mothers who had had a LBW baby and 29 age-matched controls who had normal birthweight babies (NBW) in order to discover whether there were differences between their diets and beliefs and attitudes to healthy eating.
Results The LBW group were significantly more likely to have lost weight prior to conception (3–6 months before) while the NBW mothers were more likely to have gained weight prior to conception. The LBW group were more likely to have had a previous LBW baby. Only 9% of mothers changed their diet in anticipation of pregnancy with only 7% of mothers having taken folic acid prior to conception (although most of the questionnaires were administered prior to the folic acid campaign).
Conclusion and recommendations The majority of mothers welcomed more information on nutrition in relation to preconception care and indicated that booklets would be the most appreciated form of receiving this information. This may encourage mothers to make appropriate changes to their diet before conception, including taking folic acid. It is proposed that a nationwide booklet be made widely available to all women of reproductive age which highlights the important preconception points.     

Low birth weight: an outcome of poor socio-obstetric interaction

Factors contributing to low birth weight (LBW) include poverty, ignorance, and inability to use health care services. Early marriage and low family income lead to poor maternal nutrition reserves, which lead to reduced fetal nutrition. Poor maternal nutrition is also the result of ignorance, short birth intervals, multi-parity, and lack of prenatal care. Both heavy manual labor and smoking contribute to placental ischemia, which, along with reduced fetal nutrition, leads to intrauterine growth retardation (IUGR). In developing countries, IUGR accounts for over 66% of all LBW neonates. About 7 million Indian babies annually are LBW. This study examined the incidence of LBW among 178 mothers delivering single births at the maternity hospital associated with the Department of Community Medicine of SKIMS, Srinagar, Kashmir, India, during 1989-90. 26.40% (47) of the 178 births were LBW (2500 g). Among 71 first-borns, marriage age was found to be statistically significantly associated with LBW. 31.82% of mothers younger than 20 years had LBW babies, compared to only 6.12% of mothers older than 20 years. The impact ratio, which measured excess LBW, was 4.20. Birth interval was statistically significantly associated with LBW outcome. 55.81% of women with a birth interval of less than 18 months had LBW babies, compared to 20.31% of mothers with longer birth intervals. The impact ratio was 1.75. Gravidity was also statistically associated with LBW babies. 34.58% of multigravida mothers had LBW babies, compared to 14.08% of primigravidae. The impact ratio was 1.46. Presence of prenatal care was statistically associated; the impact ratio was 1.42. 31.30% of illiterate women had LBW babies, compared to only 17.46% among literate women, which indicated significant associations with LBW. Other significant factors were manual labor, maternal smoking, and monthly family income. Reduction of LBW by 10-30% nationally by the year 2000 will be difficult and best accomplished by a high risk approach supplemented by health and nutrition education.     

Reliability of Gestational Weight Gain Reported Postpartum: A Comparison to the Birth Certificate

Gestational weight gain (GWG) is an important predictor of short- and long-term adverse maternal and child outcomes. As interest in long-term outcomes increases, utilization of maternal postpartum report is likely to also increase. There is little data available examining the reliability and identifying predictors of bias in GWG recalled by mothers postpartum. We used data from the Early Childhood Longitudinal Study-Birth Cohort, a national study of U.S. children born in 2001, to compare GWG recalled by mothers approximately 10 months postpartum to GWG recorded on the birth certificate, among 5,650 records. On average, the postpartum estimates were 2.1 lbs higher (standard error, 0.2 lbs.) than the birth certificate report; 54.7 % were within 5 lbs, 27.2 % were overreported by more than 5 lbs, and 18.2 % were underreported by more than 5 lbs. The difference between the two sources increased with GWG reported postpartum and was significantly greater among mothers who were obese prior to pregnancy, had inadequate prenatal care, or were multiparous. Bias also differed by birth outcome, indicating the potential for recall bias. When categorized by adequacy of the 2009 Institute of Medicine GWG recommendations, 70 % of women were similarly categorized, and associations between GWG adequacy and small- and large-birthweight-for-gestational-age did not differ meaningfully by source of GWG data. These results suggest that for future studies, mothers’ estimates of their GWG, obtained within approximately 1 year postpartum, may be a reliable substitute when birth certificate GWG data are unavailable.     

Congenital malformations in Rio de Janeiro, Brazil: prevalence and associated factors

This study aims to estimate the prevalence of congenital malformations and their correlation with socioeconomic and maternal variables. The design was cross-sectional, based on a sample of 9,386 postpartum women after admission for childbirth in maternity hospitals in the city of Rio de Janeiro, Brazil. Data were collected through interviews with mothers in the immediate postpartum, as well as by consulting the patient records of both the mothers and newborn infants. Prevalence of congenital malformations at birth was 1.7%, and minor malformations were the most frequent. Neural tube defects were the most frequent major malformations. According to multivariate analysis, congenital malformations were statistically associated with: maternity hospitals belonging to or outsourced by the Unified National Health System (SUS) and inadequate prenatal care (相似文献   

A comparison of capitated and fee-for-service Medicaid reimbursement methods on pregnancy outcomes.

OBJECTIVE: To determine if the payment method influenced the likelihood of selected obstetrical process measures and pregnancy outcome indicators among Medicaid women. DATA SOURCE/STUDY SETTING: Data from the live birth certificates computer file for 1993 from the State of California. The computer files contain information about the demographic characteristics of the mother, her medical conditions prior to delivery, medical problems during labor and delivery, delivery method, newborn and maternal outcomes, and expected principal source of payment for prenatal care and for hospital delivery. STUDY DESIGN: The study sample consisted of singleton live births to women in the California Medi-Cal program residing in one of two counties in which a mixed-model managed care plan was the method of reimbursement or in one of three counties in which fee-for-service was the payment method. The study and control counties were matched in terms of geographic proximity and sociodemographics. PRINCIPAL FINDINGS: Among Medi-Cal women, the likelihood of low birth weight (LBW) was lower in the capitated payment group than in the fee-for-service payment group even when controlling for maternal and newborn characteristics and adequacy of prenatal care. There was no difference in either the adequacy of prenatal care, the cesarean birth rate, or the likelihood of adverse pregnancy outcomes other than LBW between the two payer groups. CONCLUSIONS: Results of this "natural experiment" suggest that enrollment of pregnant Medi-Cal beneficiaries in capitated healthcare services through a primary care case management system in a county-organized health system/health insuring organization can have a beneficial effect on low birth weight and provide care comparable to a fee-for-service system.     

Assessing Indian public health standards for community health centers: a case study with special reference to essential newborn care services

The main objective of the study is to identify the availability of infrastructure facility, human resources, investigative services, and facility based newborn care services with respect to Indian Public Health Standards (IPHS) at community health centers (CHC) of Bharatpur District of Rajasthan State. Data were collected from service providers at CHC through well structured questionnaire at thirteen CHCs situated at Bharatpur District of Rajasthan State. It was found that infrastructure facilities were available in almost all the CHCs, but shortage of manpower especially specialists was observed. Availability of investigative services was found quite satisfactory except ECG. It was also observed that none of the CHCs have fully equipped facility based newborn care services (including newborn corner and newborn care stabilization unit). As per IPHS suggested in the revised draft (2010) important deficiencies were revealed in the studied CHCs of Bharatpur district and by additional inputs such as recruiting staff, improving infrastructure facilities, CHCs can be upgraded.     

The neighborhood contribution to black-white perinatal disparities: an example from two north Carolina counties, 1999-2001

Previous studies of black-white disparities in perinatal outcomes have generally not controlled for both observed and unobserved neighborhood inequalities with models that compare only black and white women living in the same neighborhoods. Using 1999-2001 birth certificate data from 2 counties in North Carolina, the authors employed a hybrid fixed-effects approach to assess the total contribution of neighborhood factors to both absolute and relative racial disparities in low birth weight, preterm birth (PTB), and smallness for gestational age at term. Neighborhood factors made a notable contribution to racial disparities for PTB only, accounting for an additional 15% reduction in crude disparities beyond individual sociodemographic characteristics, which accounted for approximately 40% of racial disparities. The neighborhood contribution was greater for moderate PTB (32-36 weeks' gestation) than for very PTB (<32 weeks' gestation). A neighborhood deprivation index accounted for a smaller percentage of PTB disparities than the hybrid fixed-effects estimates, which suggests that measured socioeconomic deprivation does not account for all health-relevant neighborhood inequalities. Contemporaneous individual-level sociodemographic and neighborhood factors together explained one- to two-thirds of perinatal disparities. To fully explain racial disparities in perinatal outcomes, evaluation of other differential exposures (e.g., racism or wealth) and neighborhood factors across the life course may be necessary.