Centre for Data and Knowledge Integration for Health, Oswaldo Cruz Foundation, Salvador, Brazil.
School of Nutrition, Federal University of Bahia, Salvador, Brazil.
JAMA Netw Open. 2023 Nov 1;6(11):e2344691. doi: 10.1001/jamanetworkopen.2023.44691.
There is limited evidence of the association of conditional cash transfers, an important strategy to reduce poverty, with prevention of adverse birth-related outcomes.
To investigate the association between receiving benefits from the Bolsa Família Program (BFP) and birth weight indicators.
DESIGN, SETTING, AND PARTICIPANTS: This cohort study used a linked data resource, the Centro de Integracao de Dados e Conhecimentos Para Saude (CIDACS) birth cohort. All live-born singleton infants born to mothers registered in the cohort between January 2012 and December 2015 were included. Each analysis was conducted for the overall population and separately by level of education, self-reported maternal race, and number of prenatal appointments. Data were analyzed from January 3 to April 24, 2023.
Live births of mothers who had received BFP until delivery (for a minimum of 9 months) were classified as exposed and compared with live births from mothers who did not receive the benefit prior to delivery.
Low birth weight (LBW), birth weight in grams, and small for gestational age (SGA) were evaluated. Analytical methods used included propensity score estimation, kernel matching, and weighted logistic and linear regressions. Race categories included Parda, which translates from Portuguese as "brown" and is used to denote individuals whose racial background is predominantly Black and those with multiracial or multiethnic ancestry, including European, African, and Indigenous origins.
A total of 4 277 523 live births (2 085 737 females [48.8%]; 15 207 among Asian [0.4%], 334 225 among Black [7.8%], 29 115 among Indigenous [0.7%], 2 588 363 among Parda [60.5%], and 1 310 613 among White [30.6%] mothers) were assessed. BFP was associated with an increase of 17.76 g (95% CI, 16.52-19.01 g) in birth weight. Beneficiaries had an 11% lower chance of LBW (odds ratio [OR], 0.89; 95% CI, 0.88-0.90). BFP was associated with a greater decrease in odds of LBW among subgroups of mothers who attended fewer than 7 appointments (OR, 0.85; 95% CI, 0.84-0.87), were Indigenous (OR, 0.73; 95% CI, 0.61-0.88), and had 3 or less years of education (OR, 0.76; 95% CI, 0.72-0.81). There was no association between BFP and SGA, except among less educated mothers, who had a reduced risk of SGA (OR, 0.83; 95% CI, 0.79-0.88).
This study found that BFP was associated with increased birth weight and reduced odds of LBW, with a greater decrease in odds of LBW among higher-risk groups. These findings suggest the importance of maintaining financial support for mothers at increased risk of birth weight-related outcomes.
重要性：条件性现金转移支付是减少贫困的重要策略，但其与不良分娩相关结局的预防之间的关联证据有限。
目的：调查巴西家庭福利计划（Bolsa Família Program，BFP）受益与出生体重指标之间的关联。
设计、地点和参与者：本队列研究使用了一个链接数据资源，即 Centro de Integracao de Dados e Conhecimentos Para Saude（CIDACS）出生队列。纳入 2012 年 1 月至 2015 年 12 月期间在队列中注册的母亲所生的所有活产单胎婴儿。每项分析均针对总体人群进行，并按教育水平、自我报告的母亲种族和产前预约次数进行分层分析。数据于 2023 年 1 月 3 日至 4 月 24 日进行分析。
暴露：直至分娩前一直接受 BFP 的母亲所生的活产儿被归类为暴露组，并与在分娩前未接受该福利的母亲所生的活产儿进行比较。
主要结局和测量：评估低出生体重（LBW）、出生体重克数和小于胎龄儿（SGA）。使用的分析方法包括倾向评分估计、核匹配以及加权逻辑回归和线性回归。种族类别包括 Parda，它从葡萄牙语翻译为“棕色”，用于表示其种族背景主要为黑人的个体以及具有多种族或多种族裔血统的个体，包括欧洲、非洲和本土起源。
结果：共评估了 4277523 例活产儿（2085737 名女性[48.8%]；15207 名亚洲裔[0.4%]、334225 名非裔[7.8%]、29115 名土著裔[0.7%]、2588363 名 Parda [60.5%]和 1310613 名白种人[30.6%]母亲）。BFP 与出生体重增加 17.76 克（95%CI，16.52-19.01 克）相关。受益人的 LBW 几率降低 11%（比值比[OR]，0.89；95%CI，0.88-0.90）。在产前预约次数少于 7 次的母亲亚组（OR，0.85；95%CI，0.84-0.87）、土著裔母亲（OR，0.73；95%CI，0.61-0.88）和受教育程度为 3 年或以下的母亲（OR，0.76；95%CI，0.72-0.81）中，BFP 与 LBW 几率降低之间存在关联。BFP 与 SGA 之间无关联，但在受教育程度较低的母亲中，SGA 的风险降低（OR，0.83；95%CI，0.79-0.88）。
结论和相关性：本研究发现，BFP 与出生体重增加和 LBW 几率降低相关，而在风险较高的群体中，LBW 几率降低的幅度更大。这些发现表明，维持对面临与出生体重相关结局风险增加的母亲的财政支持非常重要。
