scholarly journals No Strings Attached: Evaluating an Unconditional Prenatal Income Supplement Using Linked Administrative Data

2017 ◽  
Vol 1 (1) ◽  
Author(s):  
Marni Brownell ◽  
Mariette Chartier ◽  
Nathan Nickel ◽  
Dan Chateau ◽  
Joykrishna Sarkar ◽  
...  
Keyword(s):  
Birth Weight ◽  
Low Birth Weight ◽  
Pregnant Women ◽  
Administrative Data ◽  
Birth Outcomes ◽  
Gestational Age ◽  
Low Income ◽  
Large For Gestational Age ◽  
Unmeasured Confounding ◽  
Low Income Women

ABSTRACT ObjectivePerinatal outcomes have improved overall in developed countries over the last several decades but remain poor for disadvantaged populations. In Manitoba, Canada, the Healthy Baby Prenatal Benefit (HBPB), a cash transfer to low-income pregnant women, was introduced with the goal of improving perinatal outcomes. The objective of this study was to use linked administrative and program datasets to determine whether this unconditional income supplement was associated with improved birth outcomes for a low-income population. ApproachThis study used data from the PATHS Data Resource, which contains population-level health and social service records as well as program data for approximately 600,000 children in Manitoba, Canada, over a 30-year period, linkable at the individual level. All mother-newborn pairs, from 2003-2010, who met the following criteria were included for analyses: i) the mother was on social assistance (i.e., low income); ii) the infant was born in hospital; and, iii) the pair had a newborn risk screen (n=14,591), documenting factors such as prenatal alcohol and tobacco exposure and maternal and family characteristics. Low-income women who received HBPB (exposed, 10,738) were compared with low-income women who did not receive HBPB (unexposed, 3,853) on several outcomes: low birth weight, preterm, small- and large-for-gestational age, 5-minutes Apgar scores, breastfeeding initiation, neonatal readmission, and newborn hospital length of stay (LOS). Covariates from the risk screens were used to develop propensity scores to construct Inverse Probability of Treatment Weights, to balance differences between exposed and unexposed groups in regression models. Gamma sensitivity analyses assessed sensitivity to unmeasured confounding. Population attributable and preventable fractions were calculated. ResultsHBPB exposure was associated with reductions in low birth weight (adjusted risk ratio, aRR=0.71, 95% CI=0.63, 0.81), preterm (aRR=0.76 (0.69, 0.84)) and small-for-gestational age (aRR=0.90 (0.81, 0.99)) births and increases in breastfeeding (aRR=1.06 (1.03, 1.09)) and large-for-gestational age births (aRR=1.13 (1.05, 1.23)). For vaginal births, HBPB was associated with shortened LOS (mean=2.86, p<0.0001). Results for breastfeeding, low birth weight, preterm and LOS were robust to unmeasured confounding. Reductions of 21% (95% CI 13.6, 28.3) of low birth weight and 17.5% (11.2, 23.8) of preterm were associated with receipt of the HBPB. ConclusionsA modest income supplement during pregnancy was associated with improved birth outcomes for infants born to low-income women. Placing conditions on income supplements to low income pregnant women may not be necessary to promote prenatal and perinatal health. Linked administrative data can be a valuable tool for program evaluation.

scholarly journals No Strings Attached: The Impact of an Unconditional Prenatal Income Supplement on First Nations Birth and Early Childhood Outcomes

2018 ◽  
Vol 3 (4) ◽  
Author(s):  
Marni Brownell ◽  
Mariette Chartier ◽  
Nathan Nickel ◽  
Rhonda Campbell ◽  
Jennifer Enns ◽  
...  
Keyword(s):  
Early Childhood ◽  
Birth Weight ◽  
Low Birth Weight ◽  
First Nations ◽  
Birth Outcomes ◽  
Gestational Age ◽  
Low Income ◽  
Large For Gestational Age ◽  
Breastfeeding Initiation ◽  
Early Childhood Outcomes

IntroductionIn Manitoba, low-income pregnant women are eligible for the Healthy Baby Prenatal Benefit (HBPB), an unconditional income supplement provided during the second and third trimester of pregnancy. HBPB is associated with improved birth outcomes for Manitoba women; its association with birth outcomes for First Nations (Indigenous) women is unknown. Objectives and ApproachTo determine the association between HBPB and First Nations’ (FN) newborn and early childhood outcomes, we linked whole-population data from health, public health, family services and education. We included only FN women receiving income assistance during pregnancy (n=7074) to develop comparable treatment (received HBPB; n=5283) and comparison (no HBPB; n=1791) groups. Propensity score weighting adjusted for differences in maternal characteristics between groups. Multi-variable regressions compared groups on breastfeeding initiation, low birth weight, preterm birth, small- and large-for-gestational age, Apgar scores, complete immunizations at 1 and 2 years, and developmental vulnerability in kindergarten measured with the Early Development Instrument (EDI). ResultsReceipt of the HBPB was associated with reductions in low birth weight births (adjusted Relative Risk (aRR): 0.77; 95% CI: 0.63, 0.93) and preterm births (aRR: 0.78 (0.68, 0.90)), and increases in breastfeeding initiation (aRR: 1.05 (1.00, 1.09)) and large-for-gestational age births (aRR: 1.11 (1.01, 1.23)). HBPB receipt during pregnancy was also associated with increases in 1- and 2-year immunizations for FN children (aRR: 1.14 (1.09, 1.19), and aRR: 1.28 (1.19, 1.36), respectively). Reductions in the risk of being developmentally vulnerable in the language and cognitive domain of the EDI were also found for FN children whose mothers had received the HBPB during pregnancy (aRR: 0.85 (0.74, 0.97). Conclusion/ImplicationsA modest unconditional income supplement during pregnancy was associated with improved birth outcomes, increased immunization rates, and improved language and cognitive development at kindergarten for children born to low-income First Nations women. Long-term strategies to address structural inequities and the ongoing effects of colonization are also needed.

scholarly journals Premature or Small for Gestational Age Discrimination: International Multicenter Trial Protocol for Classification of the Low-Birth-Weight Newborn Through the Optical Properties of the Skin

10.2196/16477 ◽  
2020 ◽  
Vol 9 (7) ◽  
pp. e16477
Author(s):  
Zilma Reis ◽  
Gabriela Vitral ◽  
Rodney Guimarães ◽  
Juliano Gaspar ◽  
Enrico Colosimo ◽  
...  
Keyword(s):  
Birth Weight ◽  
Low Birth Weight ◽  
Gestational Age ◽  
Low Income ◽  
Small For Gestational Age ◽  
Good Practice ◽  
Optoelectronic Device ◽  
Low Income Countries ◽  
New Device ◽  
Pregnancy Dating

Background A low birth weight is an independent risk factor for adverse infant outcomes and a predictor of chronic disease in adulthood. In these situations, differentiating between prematurity and small for gestational age (SGA) or simultaneous conditions is essential to ensuring adequate care. Such diagnoses, however, depend on reliable pregnancy dating, which can be challenging in developing countries. A new medical optoelectronic device was developed to estimate gestational age (GA) at birth based on newborn skin reflection. Objective This study will aim to evaluate the device’s ability to detect prematurity or SGA, or both conditions simultaneously as well as predict short-term pulmonary complications in a cohort of low-birth-weight newborns. Methods This study protocol was designed for a multicenter cohort including referral hospitals in Brazil and Mozambique. Newborns weighing 500-2500 g will be eligible for inclusion with the best GA available, considering the limited resources of low-income countries. Comparator-GA is based on reliable last menstrual period dating or ultrasound assessment before 24 weeks’ gestation. Estimated GA at birth (Test-GA) will be calculated by applying a novel optoelectronic device to the newborn’s skin over the sole. The average difference between Test-GA and Comparator-GA will be analyzed, as will the percentage of newborns who are correctly diagnosed as preterm or SGA. In addition, in a nested case–control study, the accuracy of skin reflection in the prediction of prematurity-related respiratory problems will be evaluated. The estimated required sample size is 298 newborns. Results Teams of health professionals were trained, and standard operating procedures were developed following the good practice guidelines for the clinical investigation of medical devices for human participants. The first recruitment started in March 2019 in Brazil. Data collection is planned to end in December 2020, and the results should be available in March 2021. Conclusions The results of this clinical study have the potential to validate a new device to easily assess postnatal GA, supporting SGA identification when pregnancy dating is unreliable or unknown. Trial Registration ReBec: RBR-33rnjf; http://www.ensaiosclinicos.gov.br/rg/RBR-33rnjf/ International Registered Report Identifier (IRRID) DERR1-10.2196/16477

scholarly journals A Pilot Study of Oxytocin in Low-Income Women With a Low Birth-Weight Infant

2019 ◽  
Vol 19 (4) ◽  
pp. E12-E21 ◽  
Author(s):  
Lindsey Garfield ◽  
Diane Holditch-Davis ◽  
C. Sue Carter ◽  
Barbara L. McFarlin ◽  
Julia S. Seng ◽  
...  
Keyword(s):  
Birth Weight ◽  
Pilot Study ◽  
Low Birth Weight ◽  
Low Income ◽  
Low Birth Weight Infant ◽  
Low Income Women

scholarly journals Dengue during pregnancy and live birth outcomes: a cohort of linked data from Brazil

BMJ Open ◽  
2019 ◽  
Vol 9 (7) ◽  
pp. e023529 ◽  
Author(s):  
Enny S Paixão ◽  
Oona M Campbell ◽  
Maria Gloria Teixeira ◽  
Maria CN Costa ◽  
Katie Harron ◽  
...  
Keyword(s):  
Birth Weight ◽  
Preterm Birth ◽  
Low Birth Weight ◽  
Birth Outcomes ◽  
Live Birth ◽  
Gestational Age ◽  
Small For Gestational Age ◽  
Severe Dengue ◽  
Maternal Risk ◽  
Increased Risk

ObjectivesDengue is the most common viral mosquito-borne disease, and women of reproductive age who live in or travel to endemic areas are at risk. Little is known about the effects of dengue during pregnancy on birth outcomes. The objective of this study is to examine the effect of maternal dengue severity on live birth outcomes.Design and settingWe conducted a population-based cohort study using routinely collected Brazilian data from 2006 to 2012.ParticipatingWe linked birth registration records and dengue registration records to identify women with and without dengue during pregnancy. Using multinomial logistic regression and Firth method, we estimated risk and ORs for preterm birth (<37 weeks’ gestation), low birth weight (<2500 g) and small for gestational age (<10thcentile). We also investigated the effect of time between the onset of the disease and each outcome.ResultsWe included 16 738 000 live births. Dengue haemorrhagic fever was associated with preterm birth (OR=2.4; 95% CI 1.3 to 4.4) and low birth weight (OR=2.1; 95% CI 1.1 to 4.0), but there was no evidence of effect for small for gestational age (OR=2.1; 95% CI 0.4 to 12.2). The magnitude of the effects was higher in the acute disease period.ConclusionThis study showed an increased risk of adverse birth outcomes in women with severe dengue during pregnancy. Medical intervention to mitigate maternal risk during severe acute dengue episodes may improve outcomes for infants born to exposed mothers.

scholarly journals Risk Factors for Postpartum Depressive Symptoms in Low-Income Women With Very Low-Birth-Weight Infants

2015 ◽  
Vol 15 (1) ◽  
pp. E3-E8 ◽  
Author(s):  
Lindsey Garfield ◽  
Diane Holditch-Davis ◽  
C. Sue Carter ◽  
Barbara L. McFarlin ◽  
Dorie Schwertz ◽  
...  
Keyword(s):  
Risk Factors ◽  
Depressive Symptoms ◽  
Birth Weight ◽  
Low Birth Weight ◽  
Low Income ◽  
Very Low Birth Weight ◽  
Low Birth Weight Infants ◽  
Postpartum Depressive Symptoms ◽  
Low Income Women

Housing Transitions and Low Birth Weight Among Low-Income Women

2013 ◽  
Vol 68 (4) ◽  
pp. 269-271
Author(s):  
Michael R. Kramer ◽  
Lance A. Waller ◽  
Anne L. Dunlop ◽  
Carol R. Hogue
Keyword(s):  
Birth Weight ◽  
Low Birth Weight ◽  
Low Income ◽  
Low Income Women

scholarly journals Geospatial analysis of exposure to violent crime during pregnancy and adverse birth outcomes: Evidence from São Paulo’s Western Region Birth Cohort

2020 ◽  
Author(s):  
Angelica Carreira dos Santos ◽  
Alexandra Brentani ◽  
Günther Fink
Keyword(s):  
Socioeconomic Status ◽  
Birth Weight ◽  
Low Birth Weight ◽  
Violent Crime ◽  
Birth Outcomes ◽  
Gestational Age ◽  
Violence Exposure ◽  
Western Region ◽  
Adverse Birth Outcomes ◽  
Violent Crimes

Abstract Background Low birth weight and prematurity remain leading causes of infant mortality and morbidity globally. Although an extensive literature has highlighted the importance of socioenvironmental characteristics for birth outcomes, the role of indirect violence on health remains fairly understudied. Methods Using geocoded birth records from the ongoing Western Region Birth Cohort ( Região Oeste Coorte – ROC-Cohort) of infants born between 2012-2014 and geocoded crime reports, we assessed the associations between exposure to violent crimes during pregnancy within a 1-km radius of mother’s residence and low birth weight, preterm delivery, and being born small-for-gestational-age. Violent crime exposure was categorized into quintiles. Multivariate logistic regressions were used to examine the associations between violence exposure and birth outcomes. Models were adjusted for sex, maternal age and education, socioeconomic status, and risk factors such as hypertension, diabetes, smoking, and drinking during pregnancy. ResultsAmong the 5,268 infants included, the average crime exposure during the first two trimesters of pregnancy ranged from 0.44 violent crimes in the least exposed quintile to 12.74 crimes in the most exposed. Compared to children with the lowest violence exposure, children in the highest exposure quintile were at higher odds of being born small-for-gestational-age (1.41[1.06-1.89]), preterm (1.35[1.01-1.80]), and low birth weight (1.42[1.03-1.98]). While socioeconomic status and maternal education were positively associated with lower violence exposure, no associations were found between these characteristics and the birth outcomes. Conclusions Higher exposure to external violent crimes in the close vicinity are associated with substantial increases in the odds of adverse birth outcomes. Policies to improve neighborhood safety can contribute not only to the short-term well-being of populations but may also have large social, economic, and health benefits in the long run.

scholarly journals The Influence of Early-Life Events on Human Capital, Health Status, and Labor Market Outcomes Over the Life Course

2011 ◽  
Vol 11 (3) ◽  
Author(s):  
Rucker C Johnson ◽  
Robert F Schoeni
Keyword(s):  
Human Capital ◽  
Labor Market ◽  
Birth Weight ◽  
Low Birth Weight ◽  
Birth Outcomes ◽  
Low Income ◽  
Capital Accumulation ◽  
Fixed Effects ◽  
Economic Status ◽  
Unwanted Pregnancy

Abstract Using national data from the U.S., we find that poor health at birth and limited parental resources (including low income, lack of health insurance, and unwanted pregnancy) interfere with cognitive development and health capital in childhood, reduce educational attainment, and lead to worse labor market and health outcomes in adulthood. These effects are substantial and robust to the inclusion of sibling fixed effects and an extensive set of controls. The results reveal that low birth weight ages people in their 30s and 40s by 12 years, increases the probability of dropping out of high school by one-third, lowers labor force participation by 5 percentage points, and reduces labor market earnings by roughly 15 percent. While poor birth outcomes reduce human capital accumulation, they explain only 10 percent of the total effect of low birth weight on labor market earnings. Taken together, the evidence is consistent with a negative reinforcing intergenerational transmission of disadvantage within the family; parental economic status influences birth outcomes, birth outcomes have long reaching effects on health and economic status in adulthood, which in turn leads to poor birth outcomes for one’s own children.

scholarly journals Blood Ferritin Levels in Pregnant Women and Prediction of the Development of Fetal Intrauterine Growth Restriction

2011 ◽  
Vol 30 (4) ◽  
pp. 317-322
Author(s):  
Nemanja Višnjevac ◽  
Ljiljana Segedi ◽  
Aleksandar Ćurčić ◽  
Jovana Višnjevac ◽  
Dragan Stajić
Keyword(s):  
Birth Weight ◽  
Low Birth Weight ◽  
Pregnant Women ◽  
Gestational Age ◽  
Intrauterine Growth Restriction ◽  
Ferritin Level ◽  
Newborn Infants ◽  
Maternal Blood ◽  
Growth Restriction ◽  
Intrauterine Growth

Blood Ferritin Levels in Pregnant Women and Prediction of the Development of Fetal Intrauterine Growth RestrictionIntrauterine growth restriction is one of the leading causes of perinatal morbidity and mortality. Prediction of intrauterine growth restriction is one of the priority tasks of perinatal protection. The purpose of this study was to evaluate the levels of serum ferritin in pregnant women, which could point to a group of patients in whom possible development of fetal growth restriction could have been expected. In this investigation, we conducted a prospective study of healthy pregnant women between 30 and 32 gestational weeks, who were estimated for ferritin values. Newborn infants of low birth weight for gestational age were recorded in 8.1%. Anemia was not present in any of the patients who delivered low birth weight babies. Ferritin serum levels in mothers of the babies with low birth weight were on average 6.42 μg/L higher than in the mothers with appropriate for gestational age babies (p<0.005). ROC analysis of newborn infants birth weight and maternal blood ferritin levels showed that blood ferritin level had good predictive value. In case the recorded maternal blood ferritin values are above 13.6 μg/L, we can assume with the sensitivity of 64.7% and specificity of 91.7%, that the pregnant woman will develop a condition of intrauterine growth restriction. The missing decrease of ferritin values, erythrocytes, hemoglobin and hematocrit in the blood of healthy pregnant women between 30 and 32 gestational weeks, can with high probability point to the development of fetal intrauterine growth restriction.

scholarly journals Pregnancy-associated cancers and birth outcomes in children: a Danish and Swedish population-based register study

BMJ Open ◽  
2018 ◽  
Vol 8 (12) ◽  
pp. e022946 ◽  
Author(s):  
Natalie C Momen ◽  
Linn Håkonsen Arendt ◽  
Andreas Ernst ◽  
Jørn Olsen ◽  
Jiong Li ◽  
...  
Keyword(s):  
Logistic Regression ◽  
Birth Weight ◽  
Caesarean Section ◽  
Low Birth Weight ◽  
Birth Outcomes ◽  
Gestational Age ◽  
Apgar Score ◽  
Population Based ◽  
Register Study ◽  
Adverse Birth Outcomes

ObjectivesThis study aims to estimate the association between pregnancy-associated maternal cancers, diagnosed both prenatally and postnatally, and birth outcomes.DesignPopulation-based register study.SettingNational registers of Denmark and Sweden.ParticipantsA total of 5 523 365 children born in Denmark (1977–2008) and Sweden (1973–2006).Primary and secondary outcome measures: gestational age, birth weight, size for gestational age, Apgar score, caesarean section and sex were the outcomes of interest. ORs and relative risk ratios (RRR) with 95% CIs were estimated using logistic regression and multinomial logistic regression, respectively.ResultsIn this study, 2% of children were born to mothers with a diagnosis of cancer. Children whose mothers received a prenatal cancer diagnosis had higher risk of being born preterm (RRR: 1.77, 95% CI 1.64 to 1.90); low birth weight (RRR 1.84, 95% CI 1.69 to 2.01); low Apgar score (OR 1.36, 95% CI 1.20 to 1.56); and by caesarean section (OR: 1.69, 95% CI 1.59 to 1.80). Associations moved towards the null for analyses using postnatal diagnoses, but preterm birth (RRR: 1.13, 95% CI 1.09 to 1.17) and low birth weight (RRR: 1.14, 95% CI 1.09 to 1.18) remained statistically significant, while risk of caesarean section became so (OR: 0.95, 95% CI 0.91 to 0.98). Additionally, statistical significance was reached for large for gestational age (RRR: 1.06, 95% CI 1.01 to 1.11), high birth weight (RRR: 1.04, 95% CI 1.01 to 1.06) and caesarean section (OR: 0.95, 95% CI 0.91 to 0.98).ConclusionsResults suggest an association between pregnancy-associated cancers and adverse birth outcomes in the offspring. While this is strongest for prenatally diagnosed cancers, some smaller associations exist for postnatally diagnosed cancers, indicating that cancer itself could affect fetal development, or that cancer and adverse birth outcomes share risk factors. Future studies on maternal cancer during pregnancy should consider including some postnatal years in their exposure window.

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