Skip to main content
American Journal of Public Health logoLink to American Journal of Public Health
. 2000 Jan;90(1):85–91. doi: 10.2105/ajph.90.1.85

Improved birth outcomes among HIV-infected women with enhanced Medicaid prenatal care.

B J Turner 1, C J Newschaffer 1, J Cocroft 1, T R Fanning 1, S Marcus 1, W W Hauck 1
PMCID: PMC1446118  PMID: 10630142

Abstract

OBJECTIVES: This study evaluated the impact of enhanced prenatal care on the birth outcomes of HIV-infected women. METHODS: Medicaid claims files linked to vital statistics were analyzed for 1723 HIV-infected women delivering a live-born singleton from January 1993 to October 1995. Prenatal care program visits were indicated by rate codes. Logistic models controlling for demographic, substance use, and health care variables were used to assess the program's effect on preterm birth (less than 37 weeks) and low birthweight (less than 2500 g). RESULTS: Of the women included in the study, 75.3% participated in the prenatal care program. Adjusted program care odds were 0.58 (95% confidence interval [CI] = 0.42, 0.81) for preterm birth and 0.37 (95% CI = 0.24, 0.58) for low-birthweight deliveries in women without a usual source of prenatal care. Women with a usual source had lower odds of low-birthweight deliveries if they had more than 9 program visits. The effect of program participation persisted in sensitivity analyses that adjusted for an unmeasured confounder. CONCLUSIONS: A statewide prenatal care Medicaid program demonstrates significant reductions in the risk of adverse birth outcomes for HIV-infected women.

Full Text

The Full Text of this article is available as a PDF (296.6 KB).

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Avruch S., Cackley A. P. Savings achieved by giving WIC benefits to women prenatally. Public Health Rep. 1995 Jan-Feb;110(1):27–34. [PMC free article] [PubMed] [Google Scholar]
  2. Braveman P., Bennett T., Lewis C., Egerter S., Showstack J. Access to prenatal care following major Medicaid eligibility expansions. JAMA. 1993 Mar 10;269(10):1285–1289. [PubMed] [Google Scholar]
  3. Cunningham W. E., Hays R. D., Williams K. W., Beck K. C., Dixon W. J., Shapiro M. F. Access to medical care and health-related quality of life for low-income persons with symptomatic human immunodeficiency virus. Med Care. 1995 Jul;33(7):739–754. doi: 10.1097/00005650-199507000-00009. [DOI] [PubMed] [Google Scholar]
  4. Dubay L. C., Kenney G. M., Norton S. A., Cohen B. C. Local responses to expanded Medicaid coverage for pregnant women. Milbank Q. 1995;73(4):535–563. [PubMed] [Google Scholar]
  5. Farrow D. C., Baldwin L. M., Cawthon M. L., Connell F. A. The impact of extended maternity services on prenatal care use among Medicaid women. Am J Prev Med. 1996 Mar-Apr;12(2):103–107. [PubMed] [Google Scholar]
  6. Frick K. D., Lantz P. M. Selection bias in prenatal care utilization: an interdisciplinary framework and review of the literature. Med Care Res Rev. 1996 Dec;53(4):371–396. doi: 10.1177/107755879605300401. [DOI] [PubMed] [Google Scholar]
  7. Gold R. B., Singh S., Frost J. The Medicaid eligibility expansions for pregnant women: evaluating the strength of state implementation efforts. Fam Plann Perspect. 1993 Sep-Oct;25(5):196–207. [PubMed] [Google Scholar]
  8. Goldenberg R. L., Iams J. D., Mercer B. M., Meis P. J., Moawad A. H., Copper R. L., Das A., Thom E., Johnson F., McNellis D. The preterm prediction study: the value of new vs standard risk factors in predicting early and all spontaneous preterm births. NICHD MFMU Network. Am J Public Health. 1998 Feb;88(2):233–238. doi: 10.2105/ajph.88.2.233. [DOI] [PMC free article] [PubMed] [Google Scholar]
  9. Haas J. S., Orav E. J., Goldman L. The relationship between physicians' qualifications and experience and the adequacy of prenatal care and low birthweight. Am J Public Health. 1995 Aug;85(8 Pt 1):1087–1091. doi: 10.2105/ajph.85.8_pt_1.1087. [DOI] [PMC free article] [PubMed] [Google Scholar]
  10. Haas J. S., Udvarhelyi I. S., Morris C. N., Epstein A. M. The effect of providing health coverage to poor uninsured pregnant women in Massachusetts. JAMA. 1993 Jan 6;269(1):87–91. [PubMed] [Google Scholar]
  11. Heins H. C., Jr, Nance N. W., Ferguson J. E. Social support in improving perinatal outcome: the Resource Mothers Program. Obstet Gynecol. 1987 Aug;70(2):263–266. [PubMed] [Google Scholar]
  12. Kitahata M. M., Koepsell T. D., Deyo R. A., Maxwell C. L., Dodge W. T., Wagner E. H. Physicians' experience with the acquired immunodeficiency syndrome as a factor in patients' survival. N Engl J Med. 1996 Mar 14;334(11):701–706. doi: 10.1056/NEJM199603143341106. [DOI] [PubMed] [Google Scholar]
  13. Kotelchuck M. An evaluation of the Kessner Adequacy of Prenatal Care Index and a proposed Adequacy of Prenatal Care Utilization Index. Am J Public Health. 1994 Sep;84(9):1414–1420. doi: 10.2105/ajph.84.9.1414. [DOI] [PMC free article] [PubMed] [Google Scholar]
  14. Laine C., Markson L. E., McKee L. J., Hauck W. W., Fanning T. R., Turner B. J. The relationship of clinic experience with advanced HIV and survival of women with AIDS. AIDS. 1998 Mar 5;12(4):417–424. doi: 10.1097/00002030-199804000-00011. [DOI] [PubMed] [Google Scholar]
  15. Lewit E. M., Baker L. S., Corman H., Shiono P. H. The direct cost of low birth weight. Future Child. 1995 Spring;5(1):35–56. [PubMed] [Google Scholar]
  16. Markson L. E., Turner B. J., Houchens R., Silverman N. S., Cosler L., Takyi B. K. Association of maternal HIV infection with low birth weight. J Acquir Immune Defic Syndr Hum Retrovirol. 1996 Nov 1;13(3):227–234. doi: 10.1097/00042560-199611010-00004. [DOI] [PubMed] [Google Scholar]
  17. McDermott J., Drews C., Green D., Berg C. Evaluation of prenatal care information on birth certificates. Paediatr Perinat Epidemiol. 1997 Jan;11(1):105–121. doi: 10.1046/j.1365-3016.1997.d01-4.x. [DOI] [PubMed] [Google Scholar]
  18. Piper J. M., Mitchel E. F., Jr, Ray W. A. Presumptive eligibility for pregnant Medicaid enrollees: its effects on prenatal care and perinatal outcome. Am J Public Health. 1994 Oct;84(10):1626–1630. doi: 10.2105/ajph.84.10.1626. [DOI] [PMC free article] [PubMed] [Google Scholar]
  19. Reichman N. E., Florio M. J. The effects of enriched prenatal care services on Medicaid birth outcomes in New Jersey. J Health Econ. 1996 Aug;15(4):455–476. doi: 10.1016/s0167-6296(96)00491-2. [DOI] [PubMed] [Google Scholar]
  20. Sable M. R., Spencer J. C., Stockbauer J. W., Schramm W. F., Howell V., Herman A. A. Pregnancy wantedness and adverse pregnancy outcomes: differences by race and Medicaid status. Fam Plann Perspect. 1997 Mar-Apr;29(2):76–81. [PubMed] [Google Scholar]
  21. Sowell R. L., Seals B., Moneyham L., Guillory J., Demi A., Cohen L. Barriers to health-seeking behaviors for women infected with HIV. Nursingconnections. 1996 Fall;9(3):5–17. [PubMed] [Google Scholar]
  22. Sullivan P. S., Hanson D. L., Chu S. Y., Jones J. L., Ward J. W. Epidemiology of anemia in human immunodeficiency virus (HIV)-infected persons: results from the multistate adult and adolescent spectrum of HIV disease surveillance project. Blood. 1998 Jan 1;91(1):301–308. [PubMed] [Google Scholar]
  23. Turner B. J., Cocroft J., Newschaffer C. J., Hauck W. W., Fanning T. R., Berlin M. Sources of prenatal care data and their association with birth outcomes of HIV-infected women. Am J Public Health. 2000 Jan;90(1):118–121. doi: 10.2105/ajph.90.1.118. [DOI] [PMC free article] [PubMed] [Google Scholar]
  24. Turner B. J., Hauck W. W., Fanning T. R., Markson L. E. Cigarette smoking and maternal-child HIV transmission. J Acquir Immune Defic Syndr Hum Retrovirol. 1997 Apr 1;14(4):327–337. doi: 10.1097/00042560-199704010-00004. [DOI] [PubMed] [Google Scholar]
  25. Turner B. J., Markson L., Cocroft J., Cosler L., Hauck W. W. Clinic HIV-focused features and prevention of Pneumocystis carinii pneumonia. J Gen Intern Med. 1998 Jan;13(1):16–23. doi: 10.1046/j.1525-1497.1998.00003.x. [DOI] [PMC free article] [PubMed] [Google Scholar]
  26. Turner B. J., Markson L., Hauck W., Cocroft J., Fanning T. Prenatal care of HIV-infected women: analysis of a large New York State cohort. J Acquir Immune Defic Syndr Hum Retrovirol. 1995 Aug 1;9(4):371–378. [PubMed] [Google Scholar]
  27. Turner B. J., Markson L., Taroni F. Estimation of survival after AIDS diagnosis: CD4 T lymphocyte count versus clinical severity. J Clin Epidemiol. 1996 Jan;49(1):59–65. doi: 10.1016/0895-4356(95)00067-4. [DOI] [PubMed] [Google Scholar]
  28. Turner B. J., McKee L. J., Silverman N. S., Hauck W. W., Fanning T. R., Markson L. E. Prenatal care and birth outcomes of a cohort of HIV-infected women. J Acquir Immune Defic Syndr Hum Retrovirol. 1996 Jul;12(3):259–267. doi: 10.1097/00042560-199607000-00005. [DOI] [PubMed] [Google Scholar]

Articles from American Journal of Public Health are provided here courtesy of American Public Health Association

RESOURCES