Download Manitoba Healthy Baby Program - Canadian Public Health Association

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
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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
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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 Canada
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),
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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
Canada
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
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Manitoba Prenatal Benefit:
Eligibility
• A medical note confirming pregnancy and
expected date of delivery
• Completed application
• Net family income < $32,000
• Benefits start in 2nd trimester of pregnancy;
monthly cheque for $81.41
• Resident of Manitoba
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Hypothesis 1 – Receipt of the Healthy
Baby Prenatal Benefit will be associated
with positive perinatal outcomes
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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
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Methods
• 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
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Table 1: Variables in the Propensity Score Model
HBPB
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Mean mom age at first birth
Mean SES (SEFI)
Prenatal Screening (%)
Use alcohol during pregnancy (%)
Use drug during pregnancy (%)
Family history of a disability (%)
Smoked during pregnancy (%)
Low education (%)
Social assistance (%)
Single parent family (%)
No prenatal care before 6th month (%)
Experienced depression (%)
Experienced anxiety disorder (%)
Schizophrenia or bipolar mom (%)
Mentally challenged mom (%)
Antisocial father (%)
Antisocial mom (%)
Substanced abuse mom (%)
Isolation (%)
Experienced relation distress (%)
Violence between parents (%)
History of child abuse (%)
19.81
0.90
10.05
22.01
13.29
3.46
46.07
46.26
63.82
43.83
5.80
19.66
6.72
1.17
1.23
3.66
1.66
2.59
6.47
15.32
7.12
15.61
Not in HBPB
18.96
0.87
8.96
19.81
14.62
3.77
41.04
51.42
47.64
40.57
7.55
12.74
3.30
0.00
1.89
2.36
3.30
4.72
5.19
9.43
4.72
12.74
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
before
weighting
Low Education, Mom
Intellectual Disability Mom
after weighting
Late Prenatal Care
Relationship distress
Maternal Schizophrenia
Screened prenatally
SES – SEFI2
Single parent
Smoked during pregnancy
Social assistance
Substance Abuse, Mom
Violence
0%
5%
10%
15%
20%
25%
30%
Receipt of Healthy Baby Benefit
Decrease
RR (95 % CI)
Breastfeeding Initiation
Low 5-minutes Apgar Score
Increase
1.06 (1.03 - 1.09)*
0.93 (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 Age
0.90 (0.81 - 1.00)*
Large for Gestational Age
1.13 (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)
0.6
0.7
0.8
0.9
1.0
1.1
Relative Risk (95% CI)
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1.2
1.3
1.4
Average Length of Birth Hospital Stay
3.5
3
2.5
2
HB Benefit
No HB Benefit
1.5
1
0.5
0
Vaginal Birth
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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
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Thank You / Questions
• umanitoba.ca/centres/mchp
• facebook.com/mchp.umanitoba
• twitter.com/mchp_umanitoba (@mchp_umanitoba)
Image courtesy of Vlado: FreeDigitalPhotos.net
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