Participation in Michigan’s statewide Medicaid enhanced prenatal care program led to significant reductions in infant mortality and newborn deaths among families insured by Medicaid, according to a recent study.
Researchers determined that every 1,000 additional Medicaid-insured births in which the mother participates in the state’s Maternal Infant Health Program (MIHP) would prevent two infant deaths.
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“Our study suggests that a state Medicaid-sponsored, population-based, home-visiting enhanced prenatal care program can be a successful approach to reduce mortality risk among Medicaid-insured infants of all races,” wrote Cristian I. Meghea, Ph.D., and his associates at Michigan State University in East Lansing. “The reduced risk of death among infants participating in the enhanced prenatal care program, compared with matched nonparticipants, is consistent with previous findings on the effects of the program on health care utilization and birth outcomes.”
They estimated that program participation could prevent 28% of potential infant deaths among MIHP participants, most likely because of reduced risks of adverse birth outcomes, they reported online (Pediatrics 2015 July 6 [doi:10.1542/peds.2015-0479]).
The researchers analyzed the birth and death records and Medicaid medical claims for all 248,059 Medicaid-insured singleton children born in Michigan between Jan. 1, 2009 and Dec. 31, 2012. The team investigated maternal medical claims running from 3 months before conception through the child’s first birthday. The researchers matched mothers who participated in MIHP by the end of her second trimester with those who had no MIHP involvement, taking into account age, marital status, race/ethnicity, socioeconomic status, county of residence, any smoking in pregnancy, and having a first birth or a birth within the previous 18 months before conception.
Children who participated at all in the MIHP had 27% lower odds of death (odds ratio 0.73) in their first year of life than those with no participation, a number that ranged from 29% reduced odds for black infants to 26% reduced odds for nonblack infants. Infants in the program also had 30% lower odds of neonatal death and 22% lower odds of post neonatal death, compared with those not involved in MIHP.
Further reductions occurred in all these mortality measures when mothers enrolled in MIHP and underwent screening by the end of the second trimester of pregnancy, followed by at least three more prenatal follow-ups in the program. Among this group, odds of infant mortality dropped 30%, odds of neonatal death dropped 33%, and post neonatal death odds dropped 26%.
“Programs targeting Medicaid-insured pregnant women that bundle interventions addressing multiple determinants at multiple levels can be an important mechanism to reach underserved women and their infants at greater risk of infant death,” the authors concluded.
The Michigan Department of Community Health supported the study. The authors reported no relevant financial disclosures.