The impact of dose of the St. Louis Healthy Start program and prenatal care adequacy on birth outcomes

Abstract

The federal Healthy Start program began over 20 years ago to reduce disparities in infant mortality. Data on outcomes of the program, in particular related to the amount of exposure to Healthy Start, are lacking in the literature.  This study was designed to assess the impact of dose of a Healthy Start program on prenatal care adequacy (defined using the Kotelchuck Index) and birth outcomes. Two hundred and thirty African American women were included in the study sample.  Participants were women served by their local Healthy Start program between 2007 and 2012.  Traditional multivariable logistic and linear regression analyses were employed to determine the impact of the Healthy Start program. Dose of Healthy Start (OR = 1.296, 95% CI [1.060, 1.585]) was found to be positively predictive of prenatal care adequacy.  Because significant interaction effects were found between dose and prenatal care adequacy, the sample was then stratified by level of prenatal care adequacy, and dose was assessed as an independent variable on birth outcomes (infant birth weight and pre-term birth).  Dose was negatively predictive of infant birth weight (β = -60.015, p < .10) among women with adequate plus prenatal care; dose was positively predictive of pre-term birth (OR = 1.427, 90% CI [1.104, 1.845]) among women with adequate plus prenatal care. Dose was found to be an important predictor of birth outcomes across varying categories of prenatal care adequacy and probably works synergistically through prenatal care.  Future research should continue to explore these relationships at each level of prenatal care adequacy.