Minnesota Department of Health & Minnesota Department of Human Services
October 2010
Prenatal Care, Tobacco Use, and Teen Pregnancy:
Modifiable Risk Factors for Low Birth Weight among
Medicaid and Non-Medicaid Births in Minnesota
This fact sheet summarizes results from the report “The Birth Certificate and Medicaid Data
Match Project: A Comparison of Low Birth Weight Outcomes among Medicaid and NonMedicaid Funded Births in Minnesota.” This report examines the difference in LBW incidence
between Medicaid-funded and non-Medicaid births in Minnesota for calendar years 2005-2007.
Background
Low birth weight (LBW) is defined as a birth weight of less than 2500 grams (5.5 pounds). LBW
has both immediate and long-term impacts on health. It is a significant predictor of infant
mortality, and disabilities and hospitalizations during childhood. LBW is also associated with an
increased risk of heart disease, type 2 diabetes, and other chronic disease in adulthood.
Researchers have found several factors that are associated with higher risk of LBW, including
maternal smoking during pregnancy, lack of prenatal care, young maternal age, and
socioeconomic status.1 Some of these factors can be modified or changed to decrease the risk of
giving birth to an infant with LBW. For example, women can stop smoking before pregnancy,
and remain smoke-free during and after pregnancy. Adolescents at risk of teen pregnancy can be
encouraged to wait longer before having children. Women can be encouraged to seek prenatal
care early in pregnancy, and barriers to obtaining prenatal care can be reduced for low income
women who may have difficulty finding prenatal care.
Methods
Minnesota resident birth certificates were linked with Medicaid enrollment and claims data using
the name of the mother, the child’s date of birth, and other identifiers. Medicaid-funded births
were defined as those for which the birth certificate matched with Medicaid data. Non-Medicaid
births included the remaining birth certificates. Medicaid births include Medical Assistance and
MinnesotaCare births.
Findings
LBW was more common among Medicaid births than non-Medicaid births in Minnesota
during 2005 through 2007. Among Medicaid births, 7.9% of infants were LBW, compared
with 6.0% of non-Medicaid infants.
Because some risk factors for LBW are more common among Medicaid births than nonMedicaid births, infants were categorized by both Medicaid status and by each of three LBW risk
factors – prenatal care adequacy, tobacco use during pregnancy, and maternal age group. This
analysis was performed to examine the relationships between these LBW risk factors, Medicaid
status, and LBW.
1
March of Dimes Foundation. Low Birthweight Fact Sheet. Available at:
http://www.marchofdimes.com/professionals/14332_1153.asp. Accessed 7 September 2010.
Prenattal Care, Tobacco
T
Use, and
d Teen Prregnancy
y:
Modifia
able Risk
k Factors for Low Birth We
eight amo
ong
Medica
aid and Non-Medi
N
caid Birth
hs in Min
nnesota
Pag
ge 2
Prenata
al Care Ade
equacy
Inadequaate or no pren
natal care
was moree than three times as
common among Med
dicaid
births thaan non-Mediicaid births
(6.3% an
nd 1.9% resp
pectively).
Adequatee prenatal caare was
reported for only 67%
% of
Medicaid
d births, com
mpared with
85% of non-Medicai
n
d births.
(Adequatte prenatal care is
defined as
a prenatal caare
beginning during the first
trimesterr, and includiing an
adequate number of visits.)
v
Inadeq
quate prenaatal care is m
more commo
on among M
Medicaid birtths than non
n‐Medicaid births. Also,, more infan
nts are born with LBW in the Medica
aid populatio
on compare
ed with infan
nts whose m
mothers had the sam
me level of p
prenatal care in the non
n‐Medicaid p
population. Greater prenatal
p
caree adequacy was
w associateed with loweer percentagee of LBW innfants in bothh
Medicaid
d and non-M
Medicaid populations. Am
mong Medicaaid births, 100.8% of infaants whose
mothers had
h inadequ
uate or no preenatal care were
w LBW, ccompared wiith 6.4% of iinfants born to
mothers with
w adequaate prenatal care.
c
The corrresponding LBW figurees in the nonn-Medicaid
populatio
on were 8.2%
% and 5.1%.
When co
omparing Meedicaid and non-Medicai
n
id births by llevel of prennatal care addequacy,
Medicaid
d infants had
d a significan
ntly higher percentage
p
off LBW than non-Medicaaid infants
among th
hose born to women with
h adequate prenatal
p
care and inadequuate or no prrenatal care.
LBW
W Infants b
by Medicaiid status off birth and Prenatal C
Care Adequ
uacy Level
Populaation
Mediccaid
Adeq
quate
% LBW
W
▲= Significantl
=
ly Higher % LLBW than Non‐Medicaid
|
||||||||||||||||||||||||||||||||||||||
6.4% ||||||||||||||||||||||||||||
Interrmediate
|
||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
8.4% ||||||||||||||||||||||||||||
Prrenatal Care Ade
equacy Leve
el
Inade
equate/Non
ne
Adeq
quate
Non‐Me
edicaid Interrmediate
Inade
equate/Non
ne
|
|||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
10.8% ||||||||||||||||||||||||||||
|
|||||||||||||||||||||||
5.1% ||||||||||||||||||||||||||||
|
||||||||||||||||||||||||||||||||||||||||||||||||||
7.6% ||||||||||||||||||||||||||||
|
||||||||||||||||||||||||||||||||||||||||||||||||||||||||
8.2% ||||||||||||||||||||||||||||
Prenattal Care, Tobacco
T
Use, and
d Teen Prregnancy
y:
Modifia
able Risk
k Factors for Low Birth We
eight amo
ong
Medica
aid and Non-Medi
N
caid Birth
hs in Min
nnesota
Pag
ge 3
Tobacco Use Duriing
ncy
Pregnan
Mothers of nearly 19
9% of
Medicaid
d infants reported
tobacco use
u during pregnancy.
This rate of prenatal tobacco use
is more th
han four tim
mes as high as
a
that amon
ng non-Med
dicaid births
(4.2%).
Tob
bacco use du
uring pregnaancy is moree than four ttimes as com
mmon among Medicaaid births thaan non‐Med
dicaid birthss. Infants born to motthers who used tobacco
o during pre gnancy are more likely to be LBW, regard
dless of Med
dicaid status.
In both Medicaid
M
and
d non-Mediccaid populatiions, prenataal tobacco usse was assocciated with a
higher raate of LBW than
t
no tobacco use. Onee out of everry ten infants born to moothers who
smoked during
d
pregn
nancy were LBW
L
in the Medicaid
M
poopulation, coompared withh 7.0% of innfants
born to non-smoking
n
g mothers. In
n the non-Meedicaid popuulation, 9.2%
% of infants bborn to tobaccco
users werre LBW, com
mpared with
h 5.7% of inffants born too non-smokinng mothers.
When co
omparing birtths to non-sm
moking moth
hers in the M
Medicaid andd non-Mediccaid populatiions
to each other,
o
Medicaaid infants were
w more lik
kely to be LB
BW than non-Medicaid infants.
Howeverr, when comp
paring birthss to mother who
w reportedd tobacco usse, there wass no significaant
differencce in rate of LBW
L
betweeen Medicaid
d and non-M
Medicaid birthhs.
LBW Infants by Med
dicaid status of birth and Prenaatal Tobaccco Use
Populaation
Mediccaid
Non‐Me
edicaid
obacco Use To
Duriing Pregnanccy
No
Yess
% LBW
W
▲= Significantl
=
ly Higher % LLBW than Non‐Medicaid
|
||||||||||||||||||||||||||||||||||||||||||||
7.0% ||||||||||||||||||||||||||||
|
||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
10.2% ||||||||||||||||||||||||||||
No
|
||||||||||||||||||||||||||||||
5.7% ||||||||||||||||||||||||||||
Yess
|
|||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
9.2% ||||||||||||||||||||||||||||
Prenattal Care, Tobacco
T
Use, and
d Teen Prregnancy
y:
Modifia
able Risk
k Factors for Low Birth We
eight amo
ong
Medica
aid and Non-Medi
N
caid Birth
hs in Min
nnesota
Pag
ge 4
Teen Prregnancy
Mothers enrolled in Medicaid
M
at the
time of th
heir child’s birth
b
are on
average younger
y
than
n mothers no
ot
enrolled in Medicaid
d. Notably,
13.9% off Medicaid deliveries
d
weere
to adolesscent motherrs (under agee
20), com
mpared with 3.0%
3
of non-Medicaid
d deliveries.
Teen pregnancy (matternal age un
nder
20 years)) was associaated with an
n
elevated risk of LBW
W compared with
births to 20 to 34 yeaar olds in botth Medicaid and non-Meedicaid popuulations. Birtths to motheers
aged 35 and
a older alsso had a high
her rate of LBW
L
than birrths to 20 to 34 year olds in both
populatio
ons.
When co
omparing Meedicaid and non-Medicai
n
id births by m
maternal agee group, Medicaid infantts
were sign
nificantly mo
ore likely to be LBW thaan non-Meddicaid infantss in the 20 too 34 and 35 aand
older agee groups. There was no significant
s
diifference in rrate of LBW
W births betw
ween Medicaaid
and non-Medicaid biirths to adoleescents.
LBW Infaants by Me
edicaid stattus of birth
h and Mate
ernal Age G
Group
Populaation
Mediccaid
Unde
er 20 years
% LBW
W
▲= Significantl
=
ly Higher % LLBW than Non‐Medicaid
|
||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
8.4% ||||||||||||||||||||||||||||
20 to
o 34 years
|
||||||||||||||||||||||||||||||||||||||||||||||||||
7.6% ||||||||||||||||||||||||||||
35 ye
ears and ove
er
|
|||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
9.5% ||||||||||||||||||||||||||||
Unde
er 20 years
|
|||||||||||||||||||||||||||||||||||||||||||||||
7.3% ||||||||||||||||||||||||||||
Maternal Age Group
Non‐Me
edicaid 20 to
o 34 years
35 ye
ears and ove
er
|
||||||||||||||||||||||||||||||
5.6% ||||||||||||||||||||||||||||
|
||||||||||||||||||||||||||||||||||||||||||||
7.1% ||||||||||||||||||||||||||||
he Birth Cerrtificate and
d Medicaid Data Match
h Project: A Comparisson
The full report, “Th
B
Weigh
ht Outcomess among Meedicaid and
d Non-Mediccaid Funded
d Births in
of Low Birth
Minneso
ota,” is availlable at http
p://www.hea
alth.state.m
mn.us/divs/ch
hs/raceethn/index.htm..
Performance Measureement
Q
Improvem
ment
and Quality
PO Box 64986
St. Paaul, MN 55164-0
0986
www
w.dhs.state.mn.uss
MN
N Center for Heaalth
Stattistics
PO Box 64882
St. P
Paul, MN 551644-0082
www.health.state.m
mn.us