ARTICLE PEDIATRICS Volume 137, number 6, June 2016:e20152992 Unconditional Prenatal Income Supplement and Birth Outcomes Marni D. Brownell, PhD, a,b Mariette J. Chartier, PhD, a,b Nathan C. Nickel, PhD, a,b Dan Chateau, PhD, a,b Patricia J. Martens, PhD, a,b,† Joykrishna Sarkar, MSc, b Elaine Burland, PhD, b Douglas P. Jutte, MD, MPH, c Carole Taylor, MSc, b Robert G. Santos, PhD, a,b Alan Katz, MB, ChB, a,b On behalf of the PATHS Equity for Children Team abstract BACKGROUND AND OBJECTIVES: Perinatal outcomes have improved in developed countries but remain poor for disadvantaged populations. We examined whether an unconditional income supplement to low-income pregnant women was associated with improved birth outcomes. METHODS: This study included all mother–newborn pairs (2003–2010) in Manitoba, Canada, where the mother received prenatal social assistance, the infant was born in the hospital, and the pair had a risk screen (N = 14 591). Low-income women who received the income supplement (Healthy Baby Prenatal Benefit [HBPB], n = 10 738) were compared with low- income women who did not receive HBPB ( n = 3853) on the following factors: low birth weight, preterm, small and large for gestational age, Apgar score, breastfeeding initiation, neonatal readmission, and newborn hospital length of stay (LOS). Covariates from risk screens were used to develop propensity scores and to balance differences between groups in regression models; γ sensitivity analyses were conducted to assess sensitivity to unmeasured confounding. Population-attributable and preventable fractions were calculated. RESULTS: HBPB was associated with reductions in low birth weight (aRR, 0.71 [95% CI, 0.63–0.81]), preterm births (aRR, 0.76 [95% CI, 0.69–0.84]) and small for gestational age births (aRR, 0.90 [95% CI, 0.81–0.99]) and increases in breastfeeding (aRR, 1.06 [95% CI, 1.03–1.09]) and large for gestational age births (aRR, 1.13 [95% CI, 1.05–1.23]). For vaginal births, HBPB was associated with shortened LOS (weighted mean, 2.86; P < .0001). Results for breastfeeding, low birth weight, preterm birth, and LOS were robust to unmeasured confounding. Reductions of 21% (95% CI, 13.6–28.3) for low birth weight births and 17.5% (95% CI, 11.2–23.8) for preterm births were associated with HBPB. CONCLUSIONS: Receipt of an unconditional prenatal income supplement was associated with positive outcomes. Placing conditions on income supplements may not be necessary to promote prenatal and perinatal health. a Department of Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada; b Manitoba Centre for Health Policy, Winnipeg, Manitoba, Canada; and c School of Public Health, University of California, Berkeley, Berkeley, California † Deceased. Dr Brownell conceptualized and designed the study, interpreted the data, and drafted the manuscript; Drs Chartier, Nickel, Chateau, Burland, Jutte, Santos, and Katz contributed to the conceptualization and design of the study, as well as the interpretation of the data, and critically reviewed drafts of the manuscript; Dr Martens contributed to the conceptualization and design of the study, as well as the interpretation of the data, and critically reviewed drafts of the manuscript; she did not approve the final manuscript as submitted because she died in 2015; To cite: Brownell MD, Chartier MJ, Nickel NC, et al. Unconditional Prenatal Income Supplement and Birth Outcomes. Pediatrics. 2016;137(6):e20152992 WHAT’S KNOWN ON THIS SUBJECT: Perinatal outcomes have improved in developed countries but remain poor for socioeconomically disadvantaged populations. Evaluations of conditional income supplement programs for low-income pregnant women have yielded mixed results because of methodologic challenges. WHAT THIS STUDY ADDS: Using propensity scores to balance exposed and unexposed groups, we found that an unconditional prenatal income supplement was associated with positive perinatal results. Placing conditions on income supplements may not be necessary to promote prenatal and perinatal health. by guest on June 7, 2020 www.aappublications.org/news Downloaded from