无条件产前收入补助与出生结局

Unconditional Prenatal Income Supplement and Birth Outcomes.

作者信息

Brownell Marni D, Chartier Mariette J, Nickel Nathan C, Chateau Dan, Martens Patricia J, Sarkar Joykrishna, Burland Elaine, Jutte Douglas P, Taylor Carole, Santos Robert G, Katz Alan

机构信息

Department of Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada; Manitoba Centre for Health Policy, Winnipeg, Manitoba, Canada; and

Department of Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada; Manitoba Centre for Health Policy, Winnipeg, Manitoba, Canada; and.

出版信息

Pediatrics. 2016 Jun;137(6). doi: 10.1542/peds.2015-2992. Epub 2016 May 12.

DOI:10.1542/peds.2015-2992

PMID:27244846

Abstract

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 = 14 591). Low-income women who received the income supplement (Healthy Baby Prenatal Benefit [HBPB], n = 10 738) 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; γ 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.

摘要

背景与目的

发达国家的围产期结局已有改善，但弱势群体的结局仍较差。我们研究了向低收入孕妇提供无条件收入补助是否与改善出生结局相关。

方法

本研究纳入了加拿大曼尼托巴省2003年至2010年的所有母婴对（N = 14591），这些母婴对需满足母亲接受产前社会救助、婴儿在医院出生且进行了风险筛查。将接受收入补助（健康宝宝产前福利 [HBPB]，n = 10738）的低收入女性与未接受HBPB（n = 3853）的低收入女性在以下因素上进行比较：低出生体重、早产、小于胎龄儿和大于胎龄儿、阿氏评分、母乳喂养开始情况、新生儿再入院情况以及新生儿住院时间（LOS）。利用风险筛查中的协变量来生成倾向得分，并在回归模型中平衡组间差异；进行γ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。

结果

HBPB与低出生体重（aRR，0.71 [95% CI，0.63 - 0.81]）、早产（aRR，0.76 [95% CI，0.69 - 0.84]）和小于胎龄儿出生（aRR，0.90 [95% CI，0.81 - 0.99]）的减少以及母乳喂养（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]）的增加相关。对于阴道分娩，HBPB与住院时间缩短相关（加权均值，2.86；P <.0001）。母乳喂养、低出生体重、早产和住院时间的结果对未测量的混杂因素具有稳健性。低出生体重儿出生减少21%（95% CI，13.6 - 28.3）以及早产减少17.5%（95% CI，11.2 - 23.8）与HBPB相关。