Arizona Department of Health Services, Office of Assessment and Evaluation, Bureau of Women and Children's Health, 150 N. 18th Avenue, Phoenix, AZ, 85007-3242, USA.
Matern Child Health J. 2011 Feb;15(2):225-33. doi: 10.1007/s10995-009-0556-0.
This study compares the incidence of low birth weight among mothers enrolled in Arizona's Health Start program to a sample of non-Health Start mothers with similar medical and social risk factors. A quasi-experimental design was used to match Health Start program participants to non-participants on the basis of similar medical and social risk factors. Health Start program data were linked to birth certificate data to create a sample of 5,480 pregnant women. A logistic regression analysis was conducted to predict the likelihood of having a normal birth weight (i.e., 2,500 g or more). The findings indicate that Health Start mothers had twice as better odds of having a normal birth weight than non-Health Start mothers, even after controlling for gestational age, adequacy of prenatal care, mother's history of preterm birth, weight gain during pregnancy, alcohol and cigarette use, mother's age, education and residency. Hispanic women in the program were three times as likely to have a normal birth weight baby when compared to Hispanics who were not in the program and twice as likely as non-participant Whites. And lastly, women in urban settings had better birth outcomes, especially Hispanic women. Evidence suggests that newborn infants of mothers enrolled in the Health Start Program had better birth weight outcomes even after controlling for the effects of possible confounders. However, the program seems to affect Hispanics and non-Hispanic Whites differently; in particular, Hispanics who are in the program demonstrated the best birth outcomes. One possible explanation for the general success of the program could be that program participants reported lower cigarette use during pregnancy. A limitation of this study is that that there could be reporting bias on the part of Health Start participants about their risks to enter into the program, which is difficult to verify.
本研究比较了参加亚利桑那州健康起点（Health Start）计划的母亲与具有相似医疗和社会风险因素的非健康起点母亲的低出生体重发生率。采用准实验设计，根据相似的医疗和社会风险因素，将健康起点计划参与者与非参与者进行匹配。将健康起点计划数据与出生证明数据相联系，创建了一个有 5480 名孕妇的样本。进行逻辑回归分析，以预测正常出生体重（即 2500 克或以上）的可能性。研究结果表明，即使在控制了胎龄、产前保健充足性、母亲早产史、孕期体重增加、酒精和香烟使用、母亲年龄、教育程度和居住地点等因素后，健康起点母亲的正常出生体重的可能性是未参加健康起点母亲的两倍。此外，与未参加该计划的西班牙裔妇女相比，参加该计划的西班牙裔妇女的正常出生体重婴儿的可能性高 3 倍，与未参加该计划的非西班牙裔白人相比，其可能性高 2 倍。最后，城市环境中的妇女有更好的分娩结果，尤其是西班牙裔妇女。有证据表明，即使在控制了可能混杂因素的影响后，参加健康起点计划的母亲的新生儿出生体重结果也更好。然而，该计划似乎对西班牙裔和非西班牙裔白人的影响不同；特别是参加该计划的西班牙裔人表现出最好的分娩结果。该计划总体成功的一个可能解释是，计划参与者报告在怀孕期间吸烟的比例较低。本研究的局限性在于，健康起点参与者可能对其进入计划的风险存在报告偏差，这很难核实。
