Impact of the Healthy

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Impact of the Healthy Baby Prenatal Benefit on Perinatal Outcomes: A PATHS Equity for Children Project

Marni Brownell, PhDCPHA Annual ConferenceMay 27, 2014

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PATHS Equity: PAthways To Health and Social Equity

• Multi-disciplinary, cross-sector collaboration• Integrated KT• Use Repository to evaluate programs in childhood

– Did the program work?– Did the program reduce inequities?

• 14 separate sub-projects; integrative projectsThis Programmatic Grant to Reduce Health Inequity was supported by the Canadian Institutes of Health Research (www.cihr-irsc.gc.ca) and the Heart & Stroke Foundation of Canada

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Healthy Baby Project Team:Marni Brownell, Mariette Chartier, Pat Martens, Dan Chateau, Nathan Nickel, Elaine Burland, Doug Jutte, Joy Sarkar, Carole Taylor, Chun Yan Goh, Rob Santos

Collaborators:Joanne Waskin (HCMO), Cynthia Carr, Tamara Hes (HCMO), Shannon Dennehy (HCMO),

This Programmatic Grant to Reduce Health Inequity was supported by the Canadian Institutes of Health Research (www.cihr-irsc.gc.ca) and the Heart & Stroke Foundation of Canada

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Manitoba Healthy Baby Program• aimed at promoting pre- and perinatal

health • includes two components:

– 1) prenatal income supplement (PB)• Available to low-income pregnant women

– 2) community support programs (CSP)• Available to all women prenatally and

postnatally

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Manitoba Prenatal Benefit: Eligibility

• A medical note confirming pregnancy and expected date of delivery

• Completed application• Net family income < $32,000 • Benefits start in 2nd trimester of

pregnancy; monthly cheque for $81.41

• Resident of Manitoba

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Hypothesis 1 – Receipt of the Healthy Baby Prenatal Benefit will be associated with positive perinatal outcomes

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Outcomes examined• Low birth weight• Small for gestational age• Large for gestational age• Preterm birth• 5-minute Apgar

• Length-of-stay for birth hospitalization• Breastfeeding initiation

• Readmission within 30 days• Hospital admission first 2 years• Immunization 1 and 2 years

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• If Healthy Baby Prenatal Benefit (HBPB) is targeted to low income women, who should we compare them to?

• We chose all women receiving Income Assistance during pregnancy – all eligible for HBPB, but not all applied

• Used propensity scoring to ensure women in treatment and comparison group were comparable

Methods

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Table 1: Variables in the Propensity Score Model   HBPB Not in HBPB

Mean mom age at first birth 19.81 18.96Mean SES (SEFI) 0.90 0.87Prenatal Screening (%) 10.05 8.96Use alcohol during pregnancy (%) 22.01 19.81Use drug during pregnancy (%) 13.29 14.62Family history of a disability (%) 3.46 3.77Smoked during pregnancy (%) 46.07 41.04Low education (%) 46.26 51.42Social assistance (%) 63.82 47.64Single parent family (%) 43.83 40.57No prenatal care before 6th month (%) 5.80 7.55Experienced depression (%) 19.66 12.74Experienced anxiety disorder (%) 6.72 3.30Schizophrenia or bipolar mom (%) 1.17 0.00Mentally challenged mom (%) 1.23 1.89Antisocial father (%) 3.66 2.36Antisocial mom (%) 1.66 3.30Substanced abuse mom (%) 2.59 4.72Isolation (%) 6.47 5.19Experienced relation distress (%) 15.32 9.43Violence between parents (%) 7.12 4.72History of child abuse (%) 15.61 12.74

0% 5% 10% 15% 20% 25% 30%

before weighting

after weighting

Standardized Differences Before and After Weighting

Mother’s Age First Birth

Alcohol Use

Antisocial Dad

Antisocial Mom

Maternal Anxiety

Child Abuse Mom

Maternal Depression

Maternal Diabetes

Drug Use

Family Disability

Social Isolation

Low Education, Mom

Intellectual Disability Mom

Late Prenatal Care

Relationship distress

Maternal Schizophrenia

Screened prenatally

SES – SEFI2

Single parent

Smoked during pregnancy

Social assistance

Substance Abuse, Mom

Violence

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Receipt of Healthy Baby Benefit

  RR (95 % CI)

Breastfeeding Initiation 1.06 (1.03 - 1.09)*

Low 5-minutes Apgar Score 0.93 (0.79 - 1.09)

Low Birth Weight (< 2,500 g) 0.71 (0.63 - 0.81)*

Pre-term Birth (GA < 37 weeks) 0.76 (0.69 - 0.84)*

Small for Gestational Age 0.90 (0.81 - 1.00)*

Large for Gestational Age 1.13 (1.05 - 1.23)*

Complete Immunization (one year old) 1.13 (1.10 - 1.16)*

Complete Immunization (two year old) 1.20 (1.15 - 1.25)*

Hospital Readmission (within 28 days of birth) 1.02 (0.84 - 1.25)

Hospital Readmission (within 2 years of birth) 1.01 (0.94 - 1.09)

0.6 0.7 0.8 0.9 1.0 1.1 1.2 1.3 1.4

Relative Risk (95% CI)

Decrease Increase

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Average Length of Birth Hospital Stay

Vaginal Birth0

0.5

1

1.5

2

2.5

3

3.5

HB BenefitNo HB Benefit

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Summary of findings

• Healthy Baby Prenatal Benefit associated with:– reduction in low birth weight births– Reduction in small for gestational age births– Reduction in preterm births– Increase in large for gestational

age births– Increase in breastfeeding

initiation– Decrease in birth hospitalization LOS– Increase in 1- and 2-year immunization rates

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Thank You / Questions

• umanitoba.ca/centres/mchp • facebook.com/mchp.umanitoba• twitter.com/mchp_umanitoba (@mchp_umanitoba)

Image courtesy of Vlado: FreeDigitalPhotos.net

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