1. 1 Impact of the Healthy Baby Prenatal Benefit on Perinatal Outcomes: A PATHS Equity for Children Project Marni Brownell, PhD CPHA Annual Conference May 27, 2014

2. 2 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 projects 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 Canadawww.cihr-irsc.gc.ca

3. 3 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 Canadawww.cihr-irsc.gc.ca

4. 4 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

5. 5 Manitoba Prenatal Benefit: Eligibility A medical note confirming pregnancy and expected date of delivery Completed application Net family income < $32,000 Benefits start in 2 nd trimester of pregnancy; monthly cheque for $81.41 Resident of Manitoba

6. 6 Hypothesis 1 – Receipt of the Healthy Baby Prenatal Benefit will be associated with positive perinatal outcomes

7. 7 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

8. 8 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

9. 9 Table 1: Variables in the Propensity Score Model HBPBNot in HBPB Mean mom age at first birth19.8118.96 Mean SES (SEFI)0.900.87 Prenatal Screening (%)10.058.96 Use alcohol during pregnancy (%)22.0119.81 Use drug during pregnancy (%)13.2914.62 Family history of a disability (%)3.463.77 Smoked during pregnancy (%)46.0741.04 Low education (%)46.2651.42 Social assistance (%)63.8247.64 Single parent family (%)43.8340.57 No prenatal care before 6th month (%)5.807.55 Experienced depression (%)19.6612.74 Experienced anxiety disorder (%)6.723.30 Schizophrenia or bipolar mom (%)1.170.00 Mentally challenged mom (%)1.231.89 Antisocial father (%)3.662.36 Antisocial mom (%)1.663.30 Substanced abuse mom (%)2.594.72 Isolation (%)6.475.19 Experienced relation distress (%)15.329.43 Violence between parents (%)7.124.72 History of child abuse (%)15.6112.74

10. 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

11. 11 Receipt of Healthy Baby Benefit RR (95 % CI) Breastfeeding Initiation1.06 (1.03 - 1.09)* Low 5-minutes Apgar Score0.93 (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 Age0.90 (0.81 - 1.00)* Large for Gestational Age1.13 (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) Decrease Increase

12. 12 Average Length of Birth Hospital Stay

13. 13 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

14. 14 Thank You / Questions umanitoba.ca/centres/mchp facebook.com/mchp.umanitoba twitter.com/mchp_umanitoba (@mchp_umanitoba)twitter.com/mchp_umanitoba Image courtesy of Vlado: FreeDigitalPhotos.net

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