Unconditional Prenatal Income Supplement and Birth Outcomes
Unconditional Prenatal Income Supplement and Birth Outcomes
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DOI：
10.1542/peds.2015-2992
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发表时间：
2016-06-01
期刊：
影响因子：
8
通讯作者：
Katz, Alan
中科院分区：
文献类型：
--
作者：
Brownell, Marni D.;Chartier, Mariette J.;Katz, Alan
背景和结论：发达国家的围产期结局有所改善，但弱势群体的围产期结局仍然很差。我们研究了是否无条件的收入补助低收入孕妇与改善出生outcomes.METHODS：本研究包括所有的母亲新生儿对（2003-2010年）在加拿大马尼托巴，在那里母亲接受产前社会援助，婴儿出生在医院，和对风险筛查（N = 14591）。接受收入补助（健康婴儿产前福利[HBPB]，n = 10738）的低收入妇女与未接受HBPB的低收入妇女（n = 3853）在以下因素方面进行比较：低出生体重，早产，小于和大于胎龄，Apgar评分，母乳喂养开始，新生儿再入院和新生儿住院时间（LOS）。使用风险筛选的协变量来开发倾向评分并平衡回归模型中的组间差异;进行敏感性分析以评估对未测量混杂因素的敏感性。计算人群归因分数和可预防分数。HBPB与低出生体重的减少有关（aRR，0.71 [95% CI，0.63-0.81]），早产（aRR，0.76 [95% CI，0.69-0.84]）和小于胎龄儿（aRR，0.90 [95% CI，0.81-0.99]），母乳喂养（aRR，1.06 [95% CI，1.03-1.09]）和大于胎龄儿出生（aRR，1.13 [95% CI，1.05-1.23]）增加。对于阴道分娩，HBPB与缩短的LOS相关（加权平均值，2.86; P < .0001）。母乳喂养、低出生体重、早产和LOS的结果对于未测量的混杂因素是稳健的。低出生体重儿和早产儿分别减少21%（95%CI，13.6-28.3）和17.5%（95%CI，11.2-23.8）与HBPB有关。结论：接受无条件产前收入补贴与积极结局相关。为提高产前和围产期健康，可能没有必要对收入补贴附加条件。
BACKGROUND AND OBJECTIVES: Perinatal outcomes have improved in developed countries but remain poor for disadvantaged populations. We examined whether an unconditional income supplement to low-income pregnant women was associated with improved birth outcomes.METHODS: This study included all mother-newborn pairs (2003-2010) in Manitoba, Canada, where the mother received prenatal social assistance, the infant was born in the hospital, and the pair had a risk screen (N = 14591). Low-income women who received the income supplement (Healthy Baby Prenatal Benefit [HBPB], n = 10738) were compared with low-income women who did not receive HBPB (n = 3853) on the following factors: low birth weight, preterm, small and large for gestational age, Apgar score, breastfeeding initiation, neonatal readmission, and newborn hospital length of stay (LOS). Covariates from risk screens were used to develop propensity scores and to balance differences between groups in regression models; sensitivity analyses were conducted to assess sensitivity to unmeasured confounding. Population-attributable and preventable fractions were calculated.RESULTS: HBPB was associated with reductions in low birth weight (aRR, 0.71 [95% CI, 0.63-0.81]), preterm births (aRR, 0.76 [95% CI, 0.69-0.84]) and small for gestational age births (aRR, 0.90 [95% CI, 0.81-0.99]) and increases in breastfeeding (aRR, 1.06 [95% CI, 1.03-1.09]) and large for gestational age births (aRR, 1.13 [95% CI, 1.05-1.23]). For vaginal births, HBPB was associated with shortened LOS (weighted mean, 2.86; P < .0001). Results for breastfeeding, low birth weight, preterm birth, and LOS were robust to unmeasured confounding. Reductions of 21% (95% CI, 13.6-28.3) for low birth weight births and 17.5% (95% CI, 11.2-23.8) for preterm births were associated with HBPB.CONCLUSIONS: Receipt of an unconditional prenatal income supplement was associated with positive outcomes. Placing conditions on income supplements may not be necessary to promote prenatal and perinatal health.