IMPROVED BIRTH OUTCOMES ASSOCIATED WITH ENHANCED MEDICAID PRENATAL-CARE IN DRUG-USING WOMEN INFECTED WITH THE HUMAN-IMMUNODEFICIENCY-VIRUS

Objective: To evaluate the effectiveness of an intervention designed t o enhance Medicaid prenatal care in improving birth outcomes of drug-u sing women infected with the human immunodeficiency virus (HIV). Metho ds: Medicaid and vital statistics records were linked for 353 HIV-infe cted drug-using women delivering in 1993 and 1994 while enrolled in Ne w York State Medicaid. Of these, 68% were treated by providers partici pating in the Prenatal Care Assistance Program, designed to provide ca se management, improved continuity, referral services, and behavioral risk reduction counseling. In a series of logistic models, we estimate d adjusted odds ratios (ORs) and 95% confidence intervals (CIs) of low birth weight (less than 2500 g) and preterm delivery (before 37 weeks ), comparing women using and not using the program. Results: Women usi ng the Prenatal Care Assistance Program were significantly less likely , after adjustments were made for maternal characteristics, to have lo w birth weight infants and preterm deliveries (OR 0.52, 95% CI 0.31, 0 .89; and OR 0.57, 95% CI 0.34, 0.97, respectively). Adding measures of greater adequacy and continuity of prenatal care to the models explai ned just over 20% of the Prenatal Care Assistance Program's protective effect. The addition of maternal high-risk behavior, HIV-focused care , and drug use treatment variables altered program effect estimates le ss profoundly (together accounting for 4 and 9% of the program's prote ction against low birth weight and preterm delivery, respectively). Co nclusion: The Prenatal Care Assistance Program appeared to be successf ul in reducing the incidence of low birth weight and preterm delivery in this high-risk population. The program's success can be attributed, in part, to increased adequacy and continuity of prenatal care and, t o a lesser extent, to more frequent receipt of special services and re duced maternal high-risk behaviors. (C) 1998 by The American College o f Obstetricians and Gynecologists.