The impact of the First Steps prenatal care program on birth outcomes among women receiving Medicaid in Washington State

Objectives: To evaluate the effectiveness of First Steps, Washington State's expanded Medicaid prenatal and post-partum care program, we conducted a retrospective population-based cohort Study using birth and hospital discharge records from Washington State for 1999-2002. Methods: Birth outcomes of 19,668 First Steps participants receiving Medicaid were compared to those of 56,728 non-participating mothers receiving Medicaid. Using logistic regression, odds ratios (ORs) and 95% confidence intervals (CIs) were estimated for the association between First Steps participation and low birth weight (<2500 g), preterm birth (<37 weeks gestation), small for gestational age (<10th percentile in birth weight for Washington State infants of same gestational age and sex), and infant mortality (death prior to 12 months). Results: Adjusted for potential confounders of maternal age, race/ethnicity, education, marital status, parity, place of residence, foreign birth,and participation in other benefit programs, infants of women participating in First Steps were less likely to be of low birth weight (OR = 0.92, 95% Cl: 0.84-1.00). Among Hispanic women, compared to non-participants, participants had a reduced odds of low birth weight (OR = 0.79, 95% CI: 0.67-0.94) and preterm birth (OR = 0.85, 95% Cl: 0.74-0.98). Conclusions: These results suggest that participation in First Steps among Medicaid recipients may be particularly effective among Hispanic mothers. (C) 2009 Elsevier Ireland Ltd. All rights reserved.