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Do babies' outcomes diminish when moms are underserved prenatally?

Grace Schwane Poertner, RN, MSW, PhD, Wellness Research, a not-for-profit corporation, 119 S. Main St, Suite 203, St. Charles, MO 63301-2863, 636-946-4555, gpoertne@yahoo.com

Does inadequate prenatal care or Medicaid coverage relate to survival among infants born above very-low-birthweight (Above-VLBW: 1500 grams or more)? This study analyzes individual risk of death among infants born Above-VLBW. The population studied represents 99% of a one-year birth cohort. Data (N=275,895) are randomly sampled from linked birth/infant death records for the US cohort born in 1984; these represent the 50 states & DC. Survivors roughly represent the current US population of 19-year olds. Independent variables are: infant race (3 dichotomous for African-American, Caucasian, all others); parental (maternal age/education, marriage); maternal residence at birth - by county (3 dichotomous for urban, suburban, rural) and by state (3 Medicaid averages, including percent of poor covered by Medicaid). A dichotomous variable defines prenatal care according to Kessner's Index; inadequate prenatal care was experienced by 7.6% of survivors and 14.6% of infants who died. Medicaid coverage varied from 17% to 104% of the state's poverty population. The dependent variable is dichotomous: death or survival to 1-year of age. Logistic regression analyzes infant death odds, given Medicaid and prenatal care, while controlling for infant race and parental factors. Results: Above-VLBW infant death odds increase significantly (1) for all races with inadequate prenatal care; (2) for Caucasians, where Medicaid covers fewer of the poor. Implications: national research such as this needs to be repeated at least once a decade to guide prenatal care policymaking and to assess progress in improving infant health outcomes among all races. Financial support: AHCPR/AHRQ, NASW.

Learning Objectives:

Keywords: Prenatal Care, Infant Health

Presenting author's disclosure statement:
I do not have any significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.

Maternal, Child, and Family Health

The 132nd Annual Meeting (November 6-10, 2004) of APHA