Association of participation in a supplemental nutrition program with stillbirth by race, ethnicity, and maternal characteristics

Race, Ethnicity, and Cultural Identity Modify Postpartum Participation in the Minnesota WIC Program

OBJECTIVE

To examine the racial, ethnic and cultural differences in postpartum participation of women who participated in the Special Supplemental Nutrition Program for Women, Infants and Children (WIC) during pregnancy by completing a retrospective analysis of observational data on 35,903 women who enrolled in Minnesota WIC during pregnancy, from April 2018 to March 2020.

METHODS

Descriptive analyses were completed using chi-square tests of association to show differences in postpartum WIC participation by maternal demographics and health risk codes of the WIC participants. Binary logistic regression and multivariate logistic regression were used to obtain odds ratios to compare the likelihood of postpartum WIC participation across different races, ethnicities and cultural groups.

RESULTS

Asian/Pacific Islander, East African, Hispanic, Hmong, Multigenerational Black, and Other Black pregnant participants were more likely than White participants to return to WIC postpartum (adjusted odds ratio (AOR) 2.54, 95% confidence interval (CI) 1.87-3.46; AOR 3.35, 95% CI 2.40-4.66; 1.30, 95% CI 1.10-1.54; AOR 6.76, 95% CI 4.39-10.42; AOR 1.40, 95% CI 1.11-1.77, AOR 1.52, 95% CI 1.26-1.83, respectively). American Indian pregnant participants were less likely than White participants to return to WIC postpartum (AOR 0.70, 95% CI 0.54-0.92).

CONCLUSIONS FOR PRACTICE

These findings can help the Minnesota WIC program, as well as other WIC programs, better understand which cultural groups may need more specific outreach strategies to keep women participating in the program after giving birth. Further research is needed to understand why postpartum women choose to participate, or choose not to participate, in WIC.

Risk factors for late (28+ weeks' gestation) stillbirth in the United States, 2014-2015

BACKGROUND

In the United States (US) late stillbirth (at 28 weeks or more of gestation) occurs in 3/1000 births.

AIM

We examined risk factors for late stillbirth with the specific goal of identifying modifiable factors that contribute substantially to stillbirth burden.

SETTING

All singleton births in the US for 2014-2015.

METHODS

We used a retrospective population-based design to assess the effects of multiple factors on the risk of late stillbirth in the US. Data were drawn from the US Centers for Disease Control and Prevention live birth and fetal death data files.

RESULTS

There were 6,732,157 live and 18,334 stillbirths available for analysis (late stillbirth rate = 2.72/1000 births). The importance of sociodemographic determinants was shown by higher risks for Black and Native Hawaiian and Other Pacific Islander mothers compared with White mothers, mothers with low educational attainment, and older mothers. Among modifiable risk factors, delayed/absent prenatal care, diabetes, hypertension, and maternal smoking were associated with increased risk, though they accounted for only 3-6% of stillbirths each. Two factors accounted for the largest proportion of late stillbirths: high maternal body mass index (BMI; 15%) and infants who were small for gestational age (38%). Participation in the supplemental nutrition for women, infants and children program was associated with a 28% reduction in overall stillbirth burden.

CONCLUSIONS

This study provides population-based evidence for stillbirth risk in the US. A high proportion of late stillbirths was associated with high maternal BMI and small for gestational age, whereas participation in supplemental nutrition programs was associated with a large reduction in stillbirth burden. Addressing obesity and fetal growth restriction, as well as broadening participation in nutritional supplementation programs could reduce late stillbirths.

Application Status Among Women Enrolled in a Healthy Start Program in Arkansas for the Special Nutrition Program for Women and Children

This study aimed to examine the demographic characteristics of pregnant women in a Healthy Start program who are presumed eligible for the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC), but who have not yet applied for WIC benefits. We used a cross sectional evaluation of data collected from pregnant women (n=203) participating in a Healthy Start program. Data came from surveys administered at enrollment in the Healthy Start program from July 15th, 2019 until January 14th, 2022. The primary outcome was WIC application status, which was determined by whether the woman had applied or was receiving benefits at the time of enrollment. Covariates included race/ethnicity, marital status, insurance, education, income, age, employment, and having previous children/pregnancies. Fisher exact tests and logistic regression were used to examine associations. Approximately 65% of women had not yet applied for WIC benefits. Marshallese women (80.9%) and other NHPI women (80.0%) had the highest need for assistance. In adjusted analyses, White women (p = 0.040) and Hispanic women (p = 0.005) had lower rates of needing assistance applying for WIC than Marshallese women. There were higher rates of needing assistance in applying for women with private insurance or with no insurance and for those with higher incomes. Nearly two out of every three pregnant women who were eligible for WIC had not yet applied for benefits. The findings highlight the need for outreach for all populations that may be eligible, particularly among racial/ethnic minorities and those with higher incomes.

Maternal, Infant, and Child Health Outcomes Associated With the Special Supplemental Nutrition Program for Women, Infants, and Children : A Systematic Review

BACKGROUND

The Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) is intended to improve maternal and child health outcomes. In 2009, the WIC food package changed to better align with national nutrition recommendations.

PURPOSE

To determine whether WIC participation was associated with improved maternal, neonatal-birth, and infant-child health outcomes or differences in outcomes by subgroups and WIC enrollment duration.

DATA SOURCES

Search (January 2009 to April 2022) included PubMed, Embase, CINAHL, ERIC, Scopus, PsycInfo, and the Cochrane Central Register of Controlled Trials.

STUDY SELECTION

Included studies had a comparator of WIC-eligible nonparticipants or comparison before and after the 2009 food package change.

DATA EXTRACTION

Paired team members independently screened articles for inclusion and evaluated risk of bias.

DATA SYNTHESIS

We identified 20 observational studies. We found: moderate strength of evidence (SOE) that maternal WIC participation during pregnancy is likely associated with lower risk for preterm birth, low birthweight infants, and infant mortality; low SOE that maternal WIC participation may be associated with a lower likelihood of inadequate gestational weight gain, as well as increased well-child visits and childhood immunizations; and low SOE that child WIC participation may be associated with increased childhood immunizations. We found low SOE for differences in some outcomes by race and ethnicity but insufficient evidence for differences by WIC enrollment duration. We found insufficient evidence related to maternal morbidity and mortality outcomes.

LIMITATION

Data are from observational studies with high potential for selection bias related to the choice to participate in WIC, and participation status was self-reported in most studies.

CONCLUSION

Participation in WIC was likely associated with improved birth outcomes and lower infant mortality, and also may be associated with increased child preventive service receipt.

PRIMARY FUNDING SOURCE

Agency for Healthcare Research and Quality. (PROSPERO: CRD42020222452).

Contributors to Gender Differences in Burnout and Professional Fulfillment: A Survey of Physician Faculty

BACKGROUND

This study was conducted to describe gender differences in physician burnout and professional fulfillment and to explore their potential contributors.

METHODS

This was a single-center, cross-sectional survey study of physician faculty at Brigham and Women's Hospital, an academic medical center in Boston. The population included all physician faculty who practiced clinical medicine in 2017 (n = 2,388). The study was conducted using the Stanford Physician Wellness Survey. Burnout and professional fulfillment were the main outcome measures assessed. Other variables assessed included ratings of culture of wellness, personal resilience, and efficiency of practice factors associated with physician experience.

RESULTS

The study population consisted of 1,066 faculty, of whom 46.4% were female and 59.8% were younger than 50. Female physicians reported significantly higher rates of burnout (42.4% vs. 34.4%, p = 0.01) and lower rates of professional fulfillment (35.1% vs. 50.4%, p < 0.01) than male physicians. Female physicians reported lower ratings for self-compassion and multiple culture of wellness factors. After adjusting for demographic factors and academic rank, the study team identified multiple culture of wellness factors (perceived appreciation, schedule control, work environment diversity and inclusion) and self-compassion as attenuating the significant relationship between gender and burnout. Only perceived appreciation attenuated the significant relationship between gender and professional fulfillment.

CONCLUSION

This study demonstrated higher rates of burnout and lower rates of professional fulfillment among female vs. male physician faculty. Culture of wellness factors and self-compassion may contribute to gender differences in burnout and professional fulfillment and potentially represent modifiable targets for efforts seeking to eliminate gender disparities in physicians' workplace experiences.

Effect of Elementary School-Based Health Centers in Georgia on the Use of Preventive Services

INTRODUCTION

This study measures effects on the receipt of preventive care among children enrolled in Georgia's Medicaid or Children's Health Insurance Program associated with the implementation of new elementary school-based health centers. The study sites differed by geographic environment and predominant race/ethnicity (rural white, non-Hispanic; black, small city; and suburban Hispanic).

METHODS

A quasi-experimental treatment/control cohort study used Medicaid/Children's Health Insurance Program claims/enrollment data for children in school years before implementation (2011-2012 and 2012-2013) versus after implementation (2013-2014 to 2016-2017) of school-based health centers to estimate effects on preventive care among children with (treatment) and without (control) access to a school-based health center. Data analysis was performed in 2017-2019. There were 1,531 unique children in the treatment group with an average of 4.18 school years observed and 1,737 in the control group with 4.32 school years observed. A total of 1,243 Medicaid/Children's Health Insurance Program-insured children in the treatment group used their school-based health centers.

RESULTS

Significant increases in well-child visits (5.9 percentage points, p<0.01) and influenza vaccination (6.9 percentage points, p<0.01) were found for children with versus without a new school-based health center. This represents a 15% increase from the pre-implementation percentage (38.8%) with a well-child visit and a 25% increase in influenza vaccinations. Increases were found only in the 2 school-based health centers with predominantly minority students. The 18.7 percentage point (p<0.01) increase in diet/counseling among obese/overweight Hispanic children represented a doubling from a 15.3% baseline.

CONCLUSIONS

Implementation of elementary school-based health centers increased the receipt of key preventive care among young, publicly insured children in urban areas of Georgia, with potential reductions in racial and ethnic disparities.

Association of Special Supplemental Nutrition Program for Women, Infants, and Children With Preterm Birth and Infant Mortality

IMPORTANCE

Nearly 4 in 10 expectant mothers in the United States received Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) benefits during pregnancy between 2011 and 2017. Despite public support for the program, empirical evidence of the success of the program varies substantially.

OBJECTIVE

To assess the association of WIC program participation during pregnancy by low-income expectant mothers covered by Medicaid with infant mortality by gestational age at birth and by maternal race/ethnicity in comparison with their counterparts who did not receive WIC benefits.

DESIGN, SETTING, AND PARTICIPANTS

This cohort study obtained data from January 1, 2011, to December 31, 2017, from US live birth certificates. Data were from 11 148 261 expectant mothers who delivered live births in states that have implemented the 2003 revision of the US live birth certificate and whose insurance coverage and receipt of WIC benefits were recorded on the birth certificates. Data analysis was performed from June 2019 to October 2019.

EXPOSURES

Receipt of WIC benefits during pregnancy.

MAIN OUTCOMES AND MEASURES

The first outcome was gestational age at birth: extremely preterm (<28 weeks), very preterm (28-32 weeks), moderate-to-late preterm (32-37 weeks), and normal term (≥37 weeks) births. The second outcome was death within the first year of life.

RESULTS

Among the 11 148 261 expectant mothers who delivered live births between 2011 and 2017 and were covered by Medicaid during pregnancy, the modal age at delivery was 20 to 24 years, the predominant race/ethnicity was non-Hispanic white (4 257 790 [38.2%]), and 8 145 770 (73.1%) received WIC benefits during pregnancy. The proportion of expectant mothers covered by Medicaid who also received WIC benefits decreased from 2011 to 2017 (79.3% to 67.9%; P < .001). The odds of preterm birth compared with normal term birth were lower among expectant mothers covered by Medicaid who received WIC benefits during pregnancy compared with their counterparts who did not receive WIC benefits during pregnancy (adjusted proportional odds ratio, 0.87; 95% CI, 0.86-0.87). The odds of mortality within 1 year of birth were lower for infants whose mothers were covered by Medicaid and received WIC benefits during pregnancy compared with those who did not receive WIC benefits during pregnancy (adjusted odds ratio, 0.84; 95% CI, 0.83-0.86).

CONCLUSIONS AND RELEVANCE

This study found that receipt of WIC benefits among expectant mothers with Medicaid coverage was associated with lower risk of preterm birth and infant mortality.