Low-income pregnant women should receive adequate prenatal support services--at least one nutrition, health education and psychosocial service each trimester they are in care -- to increase their chances of having a healthy birth, according to an analysis by health policy experts at UCSF.

"The odds of a good birth outcome were three times as high if women received these support services each trimester in care, whether they were in care for one, two or all three trimesters," said Carol C. Korenbrot, associate professor, UCSF Institute for Health Policy Studies.

"Through these services, low-income women may reduce their health or social problems, gain access to needed food, housing, legal or other resources that help them comply better with medical treatments, and avoid preventable complications of pregnancy," she added.

Korenbrot is the lead author of the analysis, Explaining Variation in Birth Outcomes of Medicaid-Eligible Women with Variation in the Adequacy of Prenatal Support Services, published in the February issue of Medical Care.

Korenbrot and research colleagues conducted a year-long study to determine whether there was an association between provider compliance to prenatal care guidelines and good, less costly birth outcomes. In this study, researchers defined good birth outcomes as birth weight higher than 2500 grams and full-term births -- 36 completed weeks of pregnancy.

Based on recommendations by the Public Health Service and the National Institutes of Health, the Comprehensive Perinatal Services Program (CPSP) established regulations that women receiving Medi-Cal -- Medicaid in California -- should receive health education and nutrition assessments every trimester they are in care. In addition, they should receive psychosocial services, which include both psychological and social services.

In the study, researchers examined 3,485 medical records from a random sample of 27 CPSP-certified public hospital clinics, health department clinics, community clinics, private hospital clinics, and physician offices that provided care to at least 50 pregnant Medi-Cal eligible women a year.

Study findings indicated that low-income women whose needs for psychological support, nutrition or health information are addressed at least each trimester while they are in care, have better odds of a good birth outcome than a woman who does not receive these services.

To decrease poor birth outcomes, not only do adequate services need to be provided, but study findings also indicate the need for effective support services for low income pregnant women, according to the UCSF researchers.

"Health plans serving this population, such as Medicaid, should assess whether health care providers adhere to prenatal guidelines for these support services," Korenbrot said. "In addition, these plans should consider incentives to provide services associated with better birth outcomes."

Finally, providers should evaluate the quality of service to improve the delivery of these services, the researchers said.

Rick K. Homan, former UCSF postdoctoral fellow, assistant professor at the Health Services Research and Development, VA Medical Center, Research Triangle, North Carolina, is co-author of the study.

by Lordelyn P. del Rosario

1st appeared 2/09/98

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