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Expanding Medicaid prenatal support services reduces rate of low birthweight infants

Over 80 percent of U.S. States have expanded prenatal care services for Medicaid-insured women in an effort to reduce the high infant disease and death rates among low-income pregnant women. Washington State's expanded prenatal care program was associated with a significant reduction in the rate of low birthweight (LBW) infants among moderately high-risk women, from 18.0 percent to 13.7 percent from 1989 to 1992. In contrast, in Colorado, a control State without such a program, the rate of LBW infants among medically high-risk women increased slightly from 18.0 to 20.8 percent during the same period, according to a study supported by the Agency for Health Care Policy and Research (HS06846).

Researchers led by Laura-Mae Baldwin, M.D., M.P.H., of the University of Washington, used State vital records data linked with Medicaid files to examine the change in use of prenatal care and low birthweight rates among pregnant women in Washington who were enrolled in the Medicaid Aid to Families with Dependent Children (AFDC) program before and after initiation of expanded prenatal services. These data were then compared with AFDC-enrolled women in Colorado, where there was no similar program.

Washington's program provided assessment, education, intervention, and counseling by an interdisciplinary team of community health nurses, nutritionists, and social workers in either the home or office setting. The program also funded childbirth education, transportation, and child care during medical care, as well as a targeted case management program for Medicaid-enrolled pregnant women who were under 18, used alcohol or drugs, or were otherwise at risk of poor birth outcomes.

While the decrease in low birthweight rates for Washington's study population was greatest among medically high-risk women, there was a clinically significant reduction in the overall low birthweight rate, from 7.1 percent in 1989 to 6.4 percent in 1992. The low birthweight rate for Colorado's study population overall increased slightly from 10.4 percent to 10.6 percent.

The decrease in LBW rates in Washington was most dramatic for high-risk women with preexisting conditions, over 90 percent of whom had diabetes or chronic hypertension. Both of these conditions require frequent visits, close monitoring, and compliance with treatment, all of which the case management and support service programs were designed to encourage.

See "The effect of expanding Medicaid prenatal services on birth outcomes," by Dr. Baldwin, Eric H. Larson, Ph.D., Frederick A. Connell, M.D., M.P.H., and others, in the November 1998 American Journal of Public Health 88(11), pp. 1623-1629.

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