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Birth outcomes associated with prenatal participation in a government support programme for mothers with low incomes.

BACKGROUND
Women with low incomes are at higher risk to have low-birthweight (LBW) babies and less likely to participate in prenatal support programmes than women with higher incomes. This study examined birth outcomes among participants in the Newfoundland and Labrador Mother-Baby Nutrition Supplement (MBNS), a prenatal programme for women with low incomes that provides a monthly financial supplement and printed information on infant health and development, along with a referral to public health nursing services.


METHODS
Application data (e.g. mother's age, education) for those who applied between August 2002 and December 2004 were obtained from the Provincial Government. Birth outcomes (e.g. birthweight, weeks of gestation) were available for 1599 women. Of these, 862 were parity zero and subsequently delivered full-term infants. Comparisons were made on demographics, timeliness of enrolment and rates of full-term LBW.


RESULTS
Participants were more often single, younger and less educated than the average woman who gave birth in the Province or Canada in 2004. Women enrolled early were less likely to have a full-term LBW baby than those enrolled late (chi(2)((1)) = 4.03, P = 0.045). Mothers enrolled late had a higher rate of full-term LBW than was the case in the Province [risk ratio (RR) = 2.76, 95% confidence interval (CI) = 1.61-4.74] and Canada (RR = 2.53, 95% CI = 1.55-4.21) whereas those enrolled earlier, despite increased risk due to low income, age and education, single status and zero parity, had rates of full-term LBW on par with the Province (RR = 1.29, 95% CI = 0.71-2.32) and Canada (RR = 1.19, 95% CI = 0.68-2.08).


CONCLUSION
The MBNS is an effective intervention for improving birth outcomes in women considered at risk. The challenge is to enrol pregnant women as early as possible. Future research will examine what programme component or combination of components (e.g. financial, information, referral) affects birth outcomes.