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Journal of Epidemiology and Community Health logoLink to Journal of Epidemiology and Community Health
. 2000 Mar;54(3):233–238. doi: 10.1136/jech.54.3.233

Reduced risk of low weight births among indigent women receiving care from nurse-midwives

P Visintainer 1, J Uman 1, K Horgan 1, A Ibald 1, U Verma 1, N Tejani 1
PMCID: PMC1731631  PMID: 10746119

Abstract

STUDY OBJECTIVE—To examine the effect of a comprehensive prenatal and delivery programme administered by nurse-midwives on the risk of low weight births among indigent women.
STUDY DESIGN—Historical prospective study. Birth outcomes among the cohort were compared with all county births during the same period, adjusting for maternal age and race. Results are expressed as relative risks with 95% confidence intervals.
SETTING—An enhanced Medicaid funded pre-natal programme administered by nurse-midwives from 1992 to 1994 in Westchester County, New York.
PARTICIPANTS—Indigent mothers (n=1443), between the ages of 15 and 44, who were residents of Westchester County and indicated having Medicaid or no health care coverage.
RESULTS—There were 1474 live births among cohort mothers. Mean (SD) gestational age was 39.4 (1.9) weeks. Less than 6% of births occurred before 37 weeks gestation. The mean birth weight of cohort infants was 3365.6 (518.6) g. Only 4.1% of the cohort births were less than 2500 g. Compared with all county births, the cohort showed a 41% reduction in the risk of low weight births (RRlbw=0.59, 95%CI: 0.46 to 0.73, p<.001 ) and a 56% reduction when compared with county Medicaid births only (RR=0.44, 95%CI: 0.34 to 0.57, p<.005) adjusting for maternal age and race. Larger reductions were found for very low weight births.
CONCLUSIONS—Mothers need not be considered at high risk for adverse pregnancy outcomes based on their socioeconomic status alone. Moreover, a comprehensive prenatal programme administered by nurse-midwifes may promote a reduction in adverse pregnancy outcomes among indigent mothers.


Keywords: low birth weight; prenatal care; indigent mothers; nurse-midwife

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Selected References

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  1. Berkowitz G. S. An epidemiologic study of preterm delivery. Am J Epidemiol. 1981 Jan;113(1):81–92. doi: 10.1093/oxfordjournals.aje.a113068. [DOI] [PubMed] [Google Scholar]
  2. Buescher P. A., Roth M. S., Williams D., Goforth C. M. An evaluation of the impact of maternity care coordination on Medicaid birth outcomes in North Carolina. Am J Public Health. 1991 Dec;81(12):1625–1629. doi: 10.2105/ajph.81.12.1625. [DOI] [PMC free article] [PubMed] [Google Scholar]
  3. Cooney J. P. What determines the start of prenatal care? Prenatal care, insurance, and education. Med Care. 1985 Aug;23(8):986–997. doi: 10.1097/00005650-198508000-00006. [DOI] [PubMed] [Google Scholar]
  4. Gould J. B., LeRoy S. Socioeconomic status and low birth weight: a racial comparison. Pediatrics. 1988 Dec;82(6):896–904. [PubMed] [Google Scholar]
  5. Greenberg R. S. The impact of prenatal care in different social groups. Am J Obstet Gynecol. 1983 Apr 1;145(7):797–801. doi: 10.1016/0002-9378(83)90681-6. [DOI] [PubMed] [Google Scholar]
  6. Haddow J. E., Knight G. J., Kloza E. M., Palomaki G. E., Wald N. J. Cotinine-assisted intervention in pregnancy to reduce smoking and low birthweight delivery. Br J Obstet Gynaecol. 1991 Sep;98(9):859–865. doi: 10.1111/j.1471-0528.1991.tb13506.x. [DOI] [PubMed] [Google Scholar]
  7. Heins H. C., Jr, Nance N. W., McCarthy B. J., Efird C. M. A randomized trial of nurse-midwifery prenatal care to reduce low birth weight. Obstet Gynecol. 1990 Mar;75(3 Pt 1):341–345. [PubMed] [Google Scholar]
  8. Joseph C. L. Identification of factors associated with delayed antenatal care. J Natl Med Assoc. 1989 Jan;81(1):57–63. [PMC free article] [PubMed] [Google Scholar]
  9. Joyce T. Impact of augmented prenatal care on birth outcomes of Medicaid recipients in New York City. J Health Econ. 1999 Jan;18(1):31–67. doi: 10.1016/s0167-6296(98)00027-7. [DOI] [PubMed] [Google Scholar]
  10. Kleinman J. C., Kessel S. S. Racial differences in low birth weight. Trends and risk factors. N Engl J Med. 1987 Sep 17;317(12):749–753. doi: 10.1056/NEJM198709173171207. [DOI] [PubMed] [Google Scholar]
  11. Kleinman J. C., Madans J. H. The effects of maternal smoking, physical stature, and educational attainment on the incidence of low birth weight. Am J Epidemiol. 1985 Jun;121(6):843–855. doi: 10.1093/oxfordjournals.aje.a114055. [DOI] [PubMed] [Google Scholar]
  12. Korenbrot C. C., Gill A., Clayson Z., Patterson E. Evaluation of California's statewide implementation of enhanced perinatal services as Medicaid benefits. Public Health Rep. 1995 Mar-Apr;110(2):125–133. [PMC free article] [PubMed] [Google Scholar]
  13. Kramer M. S. Determinants of low birth weight: methodological assessment and meta-analysis. Bull World Health Organ. 1987;65(5):663–737. [PMC free article] [PubMed] [Google Scholar]
  14. Lieberman E., Ryan K. J., Monson R. R., Schoenbaum S. C. Risk factors accounting for racial differences in the rate of premature birth. N Engl J Med. 1987 Sep 17;317(12):743–748. doi: 10.1056/NEJM198709173171206. [DOI] [PubMed] [Google Scholar]
  15. Liu G. G. Birth outcomes and the effectiveness of prenatal care. Health Serv Res. 1998 Feb;32(6):805–823. [PMC free article] [PubMed] [Google Scholar]
  16. MacDorman M. F., Singh G. K. Midwifery care, social and medical risk factors, and birth outcomes in the USA. J Epidemiol Community Health. 1998 May;52(5):310–317. doi: 10.1136/jech.52.5.310. [DOI] [PMC free article] [PubMed] [Google Scholar]
  17. McLaughlin F. J., Altemeier W. A., Christensen M. J., Sherrod K. B., Dietrich M. S., Stern D. T. Randomized trial of comprehensive prenatal care for low-income women: effect on infant birth weight. Pediatrics. 1992 Jan;89(1):128–132. [PubMed] [Google Scholar]
  18. Newschaffer C. J., Cocroft J., Hauck W. W., Fanning T., Turner B. J. Improved birth outcomes associated with enhanced Medicaid prenatal care in drug-using women infected with the human immunodeficiency virus. Obstet Gynecol. 1998 Jun;91(6):885–891. doi: 10.1016/s0029-7844(98)00092-1. [DOI] [PubMed] [Google Scholar]
  19. O'Campo P., Xue X., Wang M. C., Caughy M. Neighborhood risk factors for low birthweight in Baltimore: a multilevel analysis. Am J Public Health. 1997 Jul;87(7):1113–1118. doi: 10.2105/ajph.87.7.1113. [DOI] [PMC free article] [PubMed] [Google Scholar]
  20. Olds D. L., Henderson C. R., Jr, Tatelbaum R., Chamberlin R. Improving the delivery of prenatal care and outcomes of pregnancy: a randomized trial of nurse home visitation. Pediatrics. 1986 Jan;77(1):16–28. [PubMed] [Google Scholar]
  21. Paneth N. S. The problem of low birth weight. Future Child. 1995 Spring;5(1):19–34. [PubMed] [Google Scholar]
  22. Parker J. D., Schoendorf K. C. Influence of paternal characteristics on the risk of low birth weight. Am J Epidemiol. 1992 Aug 15;136(4):399–407. doi: 10.1093/oxfordjournals.aje.a116512. [DOI] [PubMed] [Google Scholar]
  23. Sexton M., Hebel J. R. A clinical trial of change in maternal smoking and its effect on birth weight. JAMA. 1984 Feb 17;251(7):911–915. [PubMed] [Google Scholar]
  24. Showstack J. A., Budetti P. P., Minkler D. Factors associated with birthweight: an exploration of the roles of prenatal care and length of gestation. Am J Public Health. 1984 Sep;74(9):1003–1008. doi: 10.2105/ajph.74.9.1003. [DOI] [PMC free article] [PubMed] [Google Scholar]
  25. Spencer B., Thomas H., Morris J. A randomized controlled trial of the provision of a social support service during pregnancy: the South Manchester Family Worker Project. Br J Obstet Gynaecol. 1989 Mar;96(3):281–288. doi: 10.1111/j.1471-0528.1989.tb02387.x. [DOI] [PubMed] [Google Scholar]
  26. Starfield B., Shapiro S., Weiss J., Liang K. Y., Ra K., Paige D., Wang X. B. Race, family income, and low birth weight. Am J Epidemiol. 1991 Nov 15;134(10):1167–1174. doi: 10.1093/oxfordjournals.aje.a116020. [DOI] [PubMed] [Google Scholar]
  27. Tucker J. M., Goldenberg R. L., Davis R. O., Copper R. L., Winkler C. L., Hauth J. C. Etiologies of preterm birth in an indigent population: is prevention a logical expectation? Obstet Gynecol. 1991 Mar;77(3):343–347. [PubMed] [Google Scholar]
  28. Turnbull D., Holmes A., Shields N., Cheyne H., Twaddle S., Gilmour W. H., McGinley M., Reid M., Johnstone I., Geer I. Randomised, controlled trial of efficacy of midwife-managed care. Lancet. 1996 Jul 27;348(9022):213–218. doi: 10.1016/s0140-6736(95)11207-3. [DOI] [PubMed] [Google Scholar]

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