Minneso
ota Departm
ment of Hea
alth & Minne
esota Depa
artment of H
Human Serrvices
Octoberr 2010
Comp
paring Lo
ow Birth
h Weight and Lo
ow Birth
h Weightt Risk
Factors betwe
een Med
dicaid an
nd Non--Medicaid Births
s,
esota 20
005-2007
7
Minne
This fact sheet summ
marizes resultts from the report
r
“The B
Birth Certifiicate and Meedicaid Dataa
Match Prroject: A Comparison off Low Birth Weight
W
Outccomes amonng Medicaid and NonMedicaid
d Funded Birrths in Minn
nesota.” Thiss report exam
mines the diffference in L
LBW incidennce
between Medicaid-fu
unded and no
on-Medicaid
d births in M
Minnesota forr calendar yeears 2005-20007.
Background
Low birth
h weight (LB
BW) is defin
ned as a birth
h weight of lless than 25000 grams (5..5 pounds). L
LBW
has both immediate and
a long-term
m impacts on
n health. It iis a significaant predictor of infant
mortality
y, and disabillities and ho
ospitalization
ns during chiildhood. LBW
W is also associated witth an
increased
d risk of hearrt disease, ty
ype 2 diabetees, and otherr chronic dissease in adullthood.1,2
Previous research has shown thatt infants born
n to low incoome womenn are more likkely to be L
LBW
w
from
m higher inco
ome familiess.3 Income daata is not available on biirth
than infants born to women
certificattes in Minnesota, but maaternal enrolllment in Me dicaid at thee time of delivery can bee
used as a proxy for lo
ow income.
Method
ds
Minnesotta resident birth
b
certificaates were lin
nked with Meedicaid enroollment and cclaims data uusing
the namee of the moth
her, the child
d’s date of biirth, and other identifierss. Medicaid--funded birthhs
were defi
fined as thosee for which the
t birth certtificate matcched with M
Medicaid dataa. Non-Mediicaid
births inccluded the reemaining birrth certificatees. Medicaidd births incluude Medical Assistance and
MinnesottaCare births.
Findings
Overall, 7.9 percentt of Medicaiid
uring 2005-births were LBW du
2007 com
mbined, sign
nificantly
higher th
han the perccentage for
non-Med
dicaid birth
hs (6.0
percent).
parity has been consisten
nt
This disp
over timee. The figuree at right
shows the percentagee of LBW
infants fo
or Medicaid and nonMedicaid
d births for each
e
year fro
om
1997 thro
ough 2007. On
O average,
there hav
ve been one-third more
LBW delliveries among Medicaid
d
births thaan non-Mediicaid births.
Compa
aring LBW
W and LB
BW Risk Factors
F
b
between M
Medicaid
and No
on-Medic
caid Births, Minnes
sota 2005
5-2007
Pag
ge 2
Several maternal
m
ch
haracteristiccs associated with high
her or lowerr LBW risk were more
common
n among Meedicaid birth
hs than non
n-Medicaid b
births. A coomparison oof selected L
LBW
risk factors between
n the Mediccaid and non
n-Medicaid population
ns is presented below.
Materna
al Age
Mothers enrolled in Medicaid
M
at
the time of their child
d’s birth are
on averag
ge younger than
t
motherss
not enrollled in Mediccaid. Notably,
13.7% off Medicaid deliveries
d
were to adolescent
a
mothers
m
(aged
d
15 to 19)), compared with 2.9% of
o
non-Med
dicaid deliveries.
Other ressearchers hav
ve found thaat
births to teenagers haave an
elevated risk of LBW
W. Probable
reasons include delay
yed prenatal
care, poo
or nutritionall status, and
physical immaturity.4
al Race and
d
Materna
Hispaniic Ethnicity
y
The majo
ority of moth
hers in both
Medicaid
d and non-M
Medicaid
deliveries are White (57.1% of
Medicaid
d births and 86.7% of
non-Med
dicaid births)). However,
mothers who
w are Afrrican
American
n or Black, American
A
Indian, or Hispanic are
a
disproporrtionately reepresented
among Medicaid
M
deliiveries
relative to non-Mediccaid
deliveries.
Previous research has shown thatt
African American
A
wo
omen have a
particularrly high risk
k of LBW co
ompared with
h other raciaal and ethnic groups. Dissparities in bbirth
outcomess between Black and Wh
hite women may
m be partiially explainned by differrences in riskk and
protectiv
ve factors durring pregnan
ncy such as maternal
m
agee, socioeconoomic status, prenatal carre,
and mediical conditio
ons. However, the Black--White dispaarity persistss after accouunting for theese
factors. Some
S
researcchers suggesst that the accumulation of exposures over the coourse of a
mother’s lifetime hass an effect on
n her birth outcomes,
o
annd that these “life-coursee factors” maay
explain th
he differences between Black
B
and White
W
womenn’s birth outccomes.5
Compa
aring LBW
W and LB
BW Risk Factors
F
b
between M
Medicaid
and No
on-Medic
caid Births, Minnes
sota 2005
5-2007
Pag
ge 3
Materna
al Country of Birth
Mothers enrolled in Medicaid
M
at the time
of their child’s
c
birth are more lik
kely to
be foreig
gn-born than mothers nott
enrolled in Medicaid
d. In the Med
dicaid
populatio
on, 28.2 perccent of birthss were
to mothers born outsiide of the US
S,
compared
d with 12.0 percent
p
in th
he nonMedicaid
d population.
Maternall foreign-borrn status app
pears to
be a protective factorr against LBW. Past
research has found th
hat some imm
migrant
women in
n Minnesotaa and the US
S, such
as Mexiccan and Africcan-born wo
omen, have better
b
birth ooutcomes thaan their US-bborn racial aand
ethnic co
ounterparts, despite
d
their lower socio
oeconomic sttatus on averrage. Possible explanatioons
for this in
nclude immiigrants’ reten
ntion of heallthy lifestylees, stronger ssocial suppoort systems, aand
better heaalth among women
w
who immigrate compared
c
too those who ddo not immiigrate.3,6,7,8,9
Materna
al Educatio
onal Attain
nment
Almost one-quarter
o
(24.9%)
(
of Medicaid
M
births weere to motherrs with less than
t
a
high scho
ool education
n, compared
d with
3.4% of non-Medicai
n
id births. Parrt of this
differencce may be beecause of thee greater
proportio
on of adolesccent motherss in the
Medicaid
d population.
Low educational attaainment has been
b
found to be associateed with higheer risk of
LBW in other studiess.10
Tobacco use duriing pregna
ancy
Nearly 19
9% of motheers of Mediccaid
births rep
ported tobacco use durin
ng
pregnanccy, more than
n four times as many
as among
g non-Mediccaid births (4
4.2%).
Smoking
g during preg
gnancy is a wellw
known caause of LBW
W. One study
y
estimated
d that 20% of
o LBW deliv
veries in
the Uniteed States cou
uld be preven
nted if
all womeen were non--smokers durring
pregnanccy.11
Compa
aring LBW
W and LB
BW Risk Factors
F
b
between M
Medicaid
and No
on-Medic
caid Births, Minnes
sota 2005
5-2007
Pag
ge 4
Prenata
al care adequacy
Inadequaate prenatal care
c is also a
risk facto
or for LBW. Inadequate or
no prenattal care was more than
three tim
mes as commo
on among
Medicaid
d births than nonMedicaid
d births (6.3%
% and 1.9%
respectiv
vely). Adequ
uate prenatal
care was reported forr only 67% of
o
Medicaid
d births, com
mpared with
d births.
85% of non-Medicai
n
(Adequatte prenatal care is defineed
as prenattal care begin
nning during
g
the first trimester,
t
an
nd including an
adequate number of visits.)
v
Low inco
ome women may
experiencce several baarriers to tim
mely initiatio
on of prenataal care, incluuding difficulty obtainingg
transporttation or chilld care for otther children
n, late pregnaancy recognnition, ambivvalence or
unhappin
ness about prregnancy, lack of knowledge of the iimportance oof early prennatal care,
negative past experieences with medical
m
proviiders, and noo regular souurce of mediical care.12,133
The full report, “Th
he Birth Cerrtificate and
d Medicaid Data Match
h Project: A Comparisson
of Low Birth
B
Weigh
ht Outcomess among Meedicaid and
d Non-Mediccaid Funded
d Births in
Minneso
ota,” is availlable at http
p://www.hea
alth.state.m
mn.us/divs/ch
hs/raceethn/index.htm..
Refere
ences
1. Goldenberg
g RL, Culhane JF. Low birth weightt in the United Stattes. Am J Clin Nuttr. 2007;85(suppl):584S-590S.
2. Langley-Ev
vans SC. Developm
mental programmiing of health and disease.
d
Proc Nutrr Soc. 2006;65(1):997-105.
3. Kramer MS
S, Seguin L, Lydon J, Goulet L. Soccio-economic dispaarities in pregnanccy outcome: why ddo the poor fare soo poorly? Paediatrric and
Perinatall Epidemiology. 20
000;14:194-210.
4. Fraser AM
M, Brockert JE, Waard RH. Associatio
on of young matern
nal age with adverrse reproductive ouutcomes. N Engl J Med.
1995;332
2(17):1113-7.
5. Lu MC, Haalfon N. Racial and
d ethnic disparities in birth outcomees: a life-course per
erspective. Maternaal and Child Heallth J. 2003;7(1):133-30.
6. MDH, Cen
nter for Health Stattistics. Births to Mexican
M
and Mexiccan American Wom
men. Minnesota V
VitalSigns. Septembber 2009;5(2). Avaailable
at: http:///www.health.state.mn.us/divs/chs/vittalsigns/mexicanm
moms2009.pdf.
7. MDH, Cen
nter for Health Stattistics. African Mo
others and their Inffants. Minnesota V
VitalSigns. Novem
mber 2008;4(2). Avvailable at:
http://ww
ww.health.state.mn
n.us/divs/chs/vitalssigns/fbblkmotherss2.pdf.
8. MDH, Cen
nter for Health Stattistics. Births to Fo
oreign-Born Mothers, 1990-2003. M
Minnesota VitalSignns. July 2005;1(4)). Available at:
http://ww
ww.health.state.mn
n.us/divs/chs/vitalssigns/foreignborn0
0705.pdf.
9. Collins JW
W Jr, David RJ. Raccial disparity in low
w birth weight and
d infant mortality. Clin Perinatol. 20009;36(1):63-73.
10. Nicolaidiss C, Ko CW, Sahaa S, Koepsell TD. Racial
R
discrepanciies in the associatioon between paternnal vs. maternal edducational level annd risk
of low birthweight in Wash
hington State. BMC
C Pregnancy Child
dbirth. 2004 Jun 1 7;4(1):10.
h consequences off smoking: a report of the Surgeon General.
G
[Atlanta, G
Ga.]: Dept. of Heaalth and Human Seervices, Centers foor
11. The health
Disease Control
C
and Preven
ntion, National Ceenter for Chronic Disease
D
Preventionn and Health Prom
motion, Office on S
Smoking and Healtth;
Washingtton, D.C. Availablle at: http://www.ccdc.gov/tobacco/daata_statistics/sgr/22004/index.htm.
12. Lia-Hoag
gberg B, Rode P, Skovholt CJ et al. Barriers
B
and motiv
vators to prenatal ccare among low-in come women. Socc Sci Med.
1990;30(4):487-95.
13. Braveman
n P, Marchi K, Egeerter S, Pearl M, Neuhaus
N
J. Barrierss to timely prenataal care among wom
men with insurance: the importance of
prepregnaancy factors. Obsttet Gynecol. 2000 Jun;95(6
J
Pt 1):874
4-80.
Perform
mance Measurem
ment
and Qu
uality Improvem
ment
PO Bo
ox 64986
St. Pau
ul, MN 55164-09
986
www.d
dhs.state.mn.us
MN Ceenter for Health
Statisticcs
PO Boxx 64882
St. Paull, MN 55164-0882
www.hhealth.state.mn.us