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Project Description

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The time extending from the prenatal period to a child’s first birthday is crucial in terms of child development and life-long health (1-3).  Factors including stressful life circumstances and  low SES can contribute to low birth weight, preterm births and intrauterine growth retardation (4-16), which in turn, have an impact on neonatal and infant morbidity and mortality (17) as well as longer-term health, cognitive and behavioural problems (3, 18-25).  Inequities for several birth outcomes exist in Manitoba, including preterm births (26), intrauterine growth retardation (26), low birth weight (27) and breastfeeding initiation (26, 28).
 
In 2001, the Healthy Baby program was introduced by the Healthy Child Manitoba Office to promote prenatal and perinatal health for low income women living in Manitoba.  The program consists of two components: 1) the Prenatal Benefit, which is an income supplement targeted at low income women, and; 2) Community Support Programs, which are educational and supportive groups available to all women from the prenatal period through to an infant’s first birthday. In 2008, in an effort to increase participation rates in Community Support Programs, women applying for the Prenatal Benefit were contacted by a Community Support Program representative to provide them with information about programs in their community. This analysis will extend previous work which found that the Healthy Baby program from 2004 to 2007 was associated with reductions in preterm birth and low birth weight births, and increases in adequate prenatal care and breastfeeding initiation (29). Additional years of data will be available to examine longer-term outcomes of children as well as measure changes in inequity over time.

Research Question

Does participation in the Healthy Baby Prenatal Benefit and/or Healthy Baby Community Support Programs improve infant outcomes and reduce socioeconomic inequities in infant outcomes?
 

Hypotheses

1. Participation in the Healthy Baby Prenatal Benefit Program will be associated with improved birth outcomes, including decreased rates of preterm births, low birth weight births and small-for-gestational age births, as well as increased breastfeeding initiation rates

2.  Participation in Healthy Baby Community Support Programs will be associated with increased rates of adequate prenatal care and increased breastfeeding initiation rates.

3. Participation in both the Healthy Baby Prenatal Benefit and Community Support Programs will be associated with reduced infant hospitalization rates.

4. The socioeconomic gap in preterm birth, low birth weight and breastfeeding initiation rates between high and low income areas will be reduced for those low income women participating in Healthy Baby compared to low income women not participating.

5. For those women receiving the Prenatal Benefit, participation rates in Community Support Programs will be higher in 2008 and later years compared to previous years.

Additional Hypotheses: For those women receiving the Prenatal Benefit, participation rates in Community Support Programs will be higher in 2008 and later years compared to previous years.
 

References

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(6) Martens PJ, Fransoo R, The Need to Know Team et al. What Works? A First Look at Evaluating Manitoba's Regional Health Programs and Policies at the Population Level. Winnipeg, MB: Manitoba  Centre for Health Policy; 2008.
 
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(16) Bindman AB, Grumbach K, Osmond D et al. Preventable hospitalizations and access to health care. JAMA 1995 July 26;274(4):305-11.
Mathews TJ, Menacker F, MacDorman MF. Infant mortality statistics from the 2001 period linked birth/infant death data set. Natl Vital Stat Rep 2003 September 15;52(2):1-28.
 
(17) Mathews TJ, Menacker F, MacDorman MF. Infant mortality statistics from the 2001 period linked birth/infant death data set. Natl Vital Stat Rep 2003 September 15;52(2):1-28.
 
(18) Breslau N, Johnson EO, Lucia VC. Academic achievement of low birthweight children at age 11: the role of cognitive abilities at school entry. J Abnorm Child Psychol 2001 August;29(4):273-9.
 
(19) Hack M, Klein NK, Taylor HG. Long-term developmental outcomes of low birth weight infants. Future Child 1995;5(1):176-96.
Huddy CL, Johnson A, Hope PL. Educational and behavioural problems in babies of 32-35 weeks gestation. Arch Dis Child Fetal Neonatal Ed 2001 July;85(1):F23-F28.
 
(20) Huddy CL, Johnson A, Hope PL. Educational and behavioural problems in babies of 32-35 weeks gestation. Arch Dis Child Fetal Neonatal Ed 2001 July;85(1):F23-F28.
 
(21) Lahti J, Raikkonen K, Kajantie E et al. Small body size at birth and behavioural symptoms of ADHD in children aged five to six years. J Child Psychol Psychiatry 2006 November;47(11):1167-74.
 
(22) Lawlor DA, Bor W, O'Callaghan MJ, Williams GM, Najman JM. Intrauterine growth and intelligence within sibling pairs: findings from the Mater-University study of pregnancy and its outcomes. Journal of Epidemiology and Community Health 2005 April;59(4):279-82.
 
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(24) Nigg JT, Breslau N. Prenatal smoking exposure, low birth weight, and disruptive behavior disorders. J Am Acad Child Adolesc Psychiatry 2007 March;46(3):362-9.
 
(25) Stein RE, Siegel MJ, Bauman LJ. Are children of moderately low birth weight at increased risk for poor health? A new look at an old question. Pediatrics 2006 July;118(1):217-23.
 
(26) Brownell M, De Coster C, Penfold R et al. Manitoba child health atlas update. Winnipeg, MB: Manitoba Centre for Health Policy; 2008.
 
(27) Brownell M, Lix L, Ekuma O et al. Why is the health status of some Manitobans not improving? The widening gap in the health status of Manitobans. Winnipeg, MB: Manitoba Centre for Health Policy; 2003.
 
(28) Martens PJ, Brownell M, Au W et al. Health inequities in Manitoba: Is the socioeconomic gap widening or narrowing over time? Winnipeg, MB: Manitoba Centre for Health Policy; 2010.
 
(29) Brownell M, Chartier M, Au W, Schultz J. Evaluation of the Healthy Baby Program. Winnipeg, MB: Manitoba Centre for Health Policy; 2010.