Breastfeeding Initiation Trends by Special Supplemental Nutrition Program for Women, Infants, and Children Participation and Race/Ethnicity Among Medicaid Births.
Describe long-term breastfeeding initiation trends by prenatal Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) participation and race/ethnicity.
Cross-sectional study of birth certificate data from 2009 to 2017 in 24 states that adopted the 2003 birth certificate revision by 2009.
Term births with hospital costs covered by Medicaid (N = 6,402,704).
Breastfeeding initiation.
The descriptive characteristics of WIC participants and WIC-eligible nonparticipants were compared by year and race/ethnicity using the chi-square test of independence or t tests. Adjusted breastfeeding initiation prevalence was estimated using linear regression models with county fixed effects, controlling for sociodemographic and obstetric/health factors. Trends were compared by WIC status overall and within racial/ethnic groups. Differences and P values were assessed using interaction terms between WIC and year.
Breastfeeding initiation increased for WIC participants and nonparticipants. Special Supplemental Nutrition Program for Women, Infants, and Children participants had lower adjusted breastfeeding initiation (2009: 69.0%; 2017: 78.5%) than nonparticipants (2009: 70.8%; 2017: 80.1%) (P < 0.001 per year). Breastfeeding initiation increased more rapidly in WIC participants than in nonparticipants for non-Hispanic Asian/Pacific Islander (21.4% and 8.6%, respectively; P < 0.001) and American Indian/Alaskan Native (13.6% and 8.1%, respectively; P = 0.02)-narrowing the gap between WIC participants and nonparticipants over time.
Annual birth certificate data provide detailed information for monitoring trends and disparities in breastfeeding initiation by prenatal WIC status. These findings can inform WIC and maternal child health program efforts to improve breastfeeding promotion for populations with low-income and racial/ethnic groups.
Thoma ME
，De Silva DA
，Kim J
，Hodges L
，Guthrie J
... -
《-》
Racial disparity in previable birth.
Extremely preterm birth of a live newborn before the limit of viability is rare but contributes uniformly to the infant mortality rate because essentially all cases result in neonatal death.
The objective of the study was to quantify racial differences in previable birth and their contribution to infant mortality and to estimate the relative influence of factors associated with live birth occurring before the threshold of viability.
This was a population-based retrospective cohort of all live births in Ohio over a 7 year period, 2006-2012. Demographic, pregnancy, and delivery characteristics of previable live births at 16 0/7 to 22 6/7 weeks of gestation were compared with a referent group of live births at 37 0/7 to 42 6/7 weeks. Rates of birth at each week of gestation were compared between black and white mothers, and relative risk ratios were calculated. Logistic regression estimated the relative risk of factors associated with previable birth, with adjustment for concomitant risk factors.
Of 1,034,552 live births in Ohio during the study period, 2607 (0.25% of all live births) occurred during the previable period of 16-22 weeks. There is a significant racial disparity in the rate and relative risk of previable birth, with a 3- to 6-fold relative risk increase in black mothers at each week of previable gestational age. The incidence of previable birth for white mothers was 1.8 per 1000 and for black mothers, 6.9 per 1000. Factors most strongly associated with previable birth, presented as adjusted relative risk ratio (95% confidence interval [CI]), were maternal characteristics of black race adjusted relative risk 2.9 (95% CI, 2.6-3.2), age ≥ 35 years 1.3 (95% CI, 1.1-1.6), and unmarried 2.1 (95% CI, 1.8-2.3); fetal characteristics including congenital anomaly, 5.4 (95% CI, 3.4-8.1) and genetic disorder, 5.1 (95% CI, 2.5-10.1); and pregnancy characteristics including prior preterm birth 4.4 (95% CI, 3.7-5.2) and multifetal gestation, twin, 16.9 (95% CI, 14.4-19.8) or triplet, 65.4 (95% CI, 32.9-130.2). The majority, 80%, of previable births (16-22 weeks) were spontaneous in nature, compared with 73% in early preterm births (23-33 weeks), 72% in late preterm births (34-36 weeks), and 65% of term births (37-42 weeks) (P < .001). Previable births constituted approximately 28% of total infant mortalities in white newborns and 45% of infant mortalities in black infants in Ohio during the study period.
There is a significant racial disparity in previable preterm births, with black mothers incurring a 3- to 6-fold increased relative risk compared with white mothers, most of which are spontaneous in nature. This may explain much of the racial disparity in infant mortality because all live-born previable preterm births result in death. Focused efforts on the prevention of spontaneous previable preterm birth may help to reduce the racial disparity in infant mortality.
DeFranco EA
，Hall ES
，Muglia LJ
《-》
Prenatal WIC Is Associated with Increased Birth Weight of Infants Born in the United States with Immigrant Mothers.
The Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) improves health outcomes for participating mothers and children. Recent immigration policy changes increased chilling effects on WIC access and utilization. Associations between WIC participation and neonatal outcomes among infants born to immigrant parents-23% of all births in the United States-are understudied.
Our aim was to examine relationships between prenatal participation in WIC and birth weight among infants of income-eligible immigrant mothers.
The study design was repeat cross-sectional in-person surveys.
Participants were 9,083 immigrant mothers of publicly insured or uninsured US-born children younger than 48 months accessing emergency departments or primary care in Baltimore, MD; Boston, MA; Little Rock, AR; Minneapolis, MN; and Philadelphia, PA interviewed from 2007 through 2017.
Outcomes were mean birth weight (in grams) and low birth weight (<2,500 g).
Multivariable linear regression assessed associations between prenatal WIC participation and mean birth weight; multivariable logistic regression examined association between prenatal WIC participation and low birth weight.
Most of the immigrant mothers (84.6%) reported prenatal WIC participation. Maternal ethnicities were as follows: 67.4% were Latina, 27.0% were Black non-Latina, 2.2% were White non-Latina, and 3.5% were other/multiple races non-Latina. Infants of prenatal WIC-participant immigrant mothers had higher adjusted mean birth weight (3,231.1 g vs 3,149.8 g; P < .001) and lower adjusted odds of low birth weight (adjusted odds ratio 0.79, 95% CI 0.65 to 0.97; P = .02) compared with infants of nonparticipants. Associations were similar among groups when stratified by mother's length of stay in United States.
Prenatal WIC participation for income-eligible immigrant mothers is associated with healthier birth weights among infants born in the United States, including for those who arrived most recently.
Ettinger de Cuba S
，Mbamalu M
，Bovell-Ammon A
，Black MM
，Cutts DB
，Lê-Scherban F
，Coleman SM
，Ochoa ER Jr
，Heeren TC
，Poblacion A
，Sandel M
，Bruce C
，Rateau LJ
，Frank DA
... -
《Journal of the Academy of Nutrition and Dietetics》
ResearchGate
(全网免费下载)
钛学术
(全网免费下载)
