Demographic Variation in Prenatal Care Coordination Receipt and Resulting Birth Outcomes: Evidence From the Wisconsin Medicaid Population.

CONTEXT: Medicaid-funded obstetric care coordination services improve birth outcomes. Whether these benefits vary by race/ethnicity or urbanicity is uncertain.

OBJECTIVE

We examined whether the associations between Wisconsin Medicaid's Prenatal Care Coordination (PNCC) program and birth outcomes varied by race/ethnicity and urbanicity.

DESIGN

Data came from a statewide cohort of birth records and linked Medicaid claims. The treatment was PNCC receipt during pregnancy for the birthing parent (none; assessment/care plan; service receipt). Covariate-adjusted conventional and sibling fixed effects linear probability models computed associations between PNCC treatment and birth outcome risks. We stratified models on birthing parent race/ethnicity (American Indian/Alaska Native non-Hispanic [NH]; Asian/Pacific Islander NH; Black NH; Hispanic; White NH; multiple NH; other NH) or on residence county urbanicity (large central metro; large fringe metro; medium metro; small metro; micropolitan; noncore).

SETTING

Wisconsin, US.

PARTICIPANTS

A total of 249 502 Medicaid-paid births (2010-2019).

MAIN OUTCOME MEASURES: Preterm birth (PTB; gestational age <37 weeks). Low birth weight (LBW; <2500 g).

RESULTS

Bias-limiting sibling fixed effects estimates indicated that PNCC's benefit is greatest among Black NH births and large central metro births. For Black NH births, PNCC service receipt was associated with a 3.3 percentage point (pp) reduction (95% CI: -4.5, -2.1pp) and a -2.9pp reduction (95% CI: -4.0, -1.7pp) in the risks of PTB and LBW, respectively. For large central metro births, PNCC service receipt was associated with a 2.7pp reduction (95% CI: -3.7, -1.7pp) and a -2.4pp reduction (95% CI: -3.4, -1.5pp) in the risks of PTB and LBW, respectively.

CONCLUSIONS

Estimates suggest that PNCC services were most effective in Black NH and urban populations. This motivates policy to improve PNCC outreach and impact in populations that stand to benefit from care coordination during pregnancy.