The effect of expanding Medicaid prenatal services on birth outcomes.

OBJECTIVES: Over 80% of US states have implemented expansions in prenatal services for Medicaid-enrolled women, including case management, nutritional and psychosocial counseling, health education, and home visiting. This study evaluates the effect of Washington State's expansion of such services on prenatal care use and low-birthweight rates. METHODS: The change in prenatal care use and low-birthweight rates among Washington's Medicaid-enrolled pregnant women before and after initiation of expanded prenatal services was compared with the change in these outcomes in Colorado, a control state. RESULTS: The percentage of expected prenatal visits completed increased significantly, from 84% to 87%, in both states. Washington's low-birthweight rate decreased (7.1% to 6.4%, P = .12), while Colorado's rate increased slightly (10.4% to 10.6%, P = .74). Washington's improvement was largely due to decreases in low-birthweight rates for medically high-risk women (18.0% to 13.7%, P = .01, for adults; 22.5% to 11.5%, P = .03, for teenagers), especially those with preexisting medical conditions. CONCLUSIONS: A statewide Medicaid-sponsored support service and case management program was associated with a decrease in the low-birthweight rate of medically high-risk women.

The impact of extended maternity services on prenatal care use among Medicaid women.

The goals of this study were to examine the use of maternity support services (MSS) and maternity case management (MCM) by Medicaid-eligible low-income pregnant women in Washington state, and to determine whether receipt of the services was associated with improved prenatal care use. We obtained data from linked birth certificates and Medicaid eligibility and claims files for women delivering between August 1989 and December 1991. Unconditional logistic regression was used to assess the programs' effects independent of other variables associated with prenatal care adequacy. The percentage of women receiving MSS and MCM was highest among women with demographic risks for adverse birth outcomes. Women receiving prenatal care from health departments or community clinics were more likely to receive MSS and MCM than those seen by private physicians or midwives. After adjustment for multiple confounding factors, we found that recipients of MSS, but not MCM, were significantly less likely than other women to receive an inadequate number of prenatal visits. Our findings suggest that public policies that pay for support services to low-income pregnant women can improve the use of prenatal care.

Smoking prevalence during pregnancy for women who are and women who are not Medicaid-funded.

Maternal smoking has been related to a number of adverse pregnancy outcomes. Although maternal smoking prevalence has decreased over time, certain populations have retained a high smoking prevalence and remain at high risk for adverse pregnancy outcomes. This study used the Washington State First Steps Program Database to estimate the difference in maternal smoking prevalence between mothers whose prenatal or delivery care was Medicaid-funded and mothers whose care was not Medicaid-funded. We evaluated differences in maternal smoking prevalence between these two groups by marital status, race, adequacy of prenatal care, and age. Among the Medicaid-funded mothers, the age-adjusted maternal smoking prevalence was 44.4% versus 16.3% for those not Medicaid-funded. Among married Medicaid-funded mothers, the smoking prevalence was 2.6 times higher in whites, 1.4 times higher in blacks, and 1.8 times higher in American Indians than for married mothers not funded by Medicaid. Among single Medicaid-funded mothers, the rate was 1.4 times higher in whites and 1.7 times higher in blacks. Differences in smoking prevalence were most apparent among older mothers. For single white and single black mothers, the smoking prevalence increased with increasing maternal age among both Medicaid-funded and other women. Adequacy of prenatal care also influences smoking prevalence. For white and black mothers, the maternal smoking prevalence was lower for those receiving adequate prenatal care than for mothers of the same race who received inadequate prenatal care. The increased maternal smoking prevalence in older single mothers and the higher maternal smoking prevalence in women with Medicaid-funded deliveries suggest that infants born to these mothers may be particularly susceptible to smoking-related health effects.

Hyperparathyroidism and pregnancy.

Six pregnancies occurring in four mothers with hyperparathyroidism have been presented. Four of the pregnancies were completed without therapy; in two, parathyroidectomy was performed. The outcome of each of the pregnancies was satisfactory. The 49 cases previously reported are reviewed. This experience demonstrates that parathyroidectomy is indicated if the mother has symptomatic hypercalcemia, and it can be safely performed during the second trimester. Pregnant women with mild, asymptomatic hypercalcemia may be followed nonoperatively during pregnancy with satisfactory outcome to both the mother and fetus.

Improved methods for purification and assay of eukaryotic messenger ribonucleic acids and ribosomes. Quantitative analysis of their interaction in a fractionated reticulocyte cell-free system.

The polyadenylic acid-containing messenger ribonucleic acids of eukaryotic cells are rapidly isolated and deproteinized in a simple and gentle one-step procedure. The polyribosome fraction, dissolved in 0.5 M NaCl/0.5 percent sodium dodecyl sulfate, is passed through an oligo(dT)-cellulose column which is then washed with the solvent until proteins and contaminating ribonucleic acids are fully removed. Deproteinized messenger ribonucleic acid is then eluted by lowering the ionic strength. This method gives highly purified and active messenger ribonucleic acids from all tissues tested. The yield is approximately 1.5 to 2 percent of the polyribosomal ribonucleic acid. Messenger ribonucleic acids are assayed in a rabbit reticulocyte-derived, messenger-dependent, cell-free protein-synthesizing system modified from Crystal et al. (Crystal, R. G., Nienhuis, A. W., Elson, N. A., and Anderson, W.F. (1972) J. Biol. Chem. 247, 5357-5368). This system synthesizes proteins at an almost linear rate for at least 2 hours. During this period, each globin messenger ribonucleic acid directs the synthesis of several globin molecules. Each active ribosome synthesizes a globin molecule every 6 to 7 min, but only a small fraction of the ribosomes or messengers are active at any instant. Translation occurs mainly on di- and monoribosomes although larger sized polysomes also occur. Several lines of evidence suggest that globin messenger ribonucleic acid requires "activation" before it can be utilized and that a messenger activation step of protein synthesis initiation is rate-limiting in this cell-free system.