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Effects of prenatal care on maternal postpartum behaviors

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Abstract

Most research on the effectiveness of prenatal care has focused on birth outcomes and has found small or no effects. It is possible, however, that prenatal care is “too little too late” to improve pregnancy outcomes in the aggregate, but that it increases the use of pediatric health care or improves maternal health-related parenting practices and, ultimately, child health. We use data from the Fragile Families and Child Wellbeing birth cohort study that have been augmented with hospital medical record data to estimate effects of prenatal care timing on pediatric health care utilization and health-related parenting behaviors during the first year of the child’s life. We focus on maternal postpartum smoking, preventive health care visits for the child, and breastfeeding. We use a multi-pronged approach to address the potential endogeneity of the timing of prenatal care. We find that first trimester prenatal care appears to decrease maternal postpartum smoking by about 5 percentage points and increase the likelihood of 4 or more well-baby visits by about 1 percentage point, and that it may also have a positive effect on breastfeeding. These findings suggest that there are benefits to standard prenatal care that are generally not considered in evaluations of prenatal care programs and interventions.

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Notes

  1. That is, we allow maternal health (and its effects) to vary over time. For example, a maternal behavior during the pregnancy, such as smoking, could have an impact on the health of the fetus (above and beyond the impact of the mother’s initial health endowment) plus it could also impact the current health of the mother.

  2. "Sufficient" visits are defined as 2 or more checkups by 2–3 months (60–122 days) of age; 3 or more checkups by 4–5 months (123–183 days) of age; or 4 or more checkups by 6–9 months (184–274 days) of age. Data reported at: http://www.cdc.gov/PRAMS/2002PRAMSSurvReport/MultiStateExhibits/Multistates17.htm.

  3. National data are based on the Center for Disease Control’s National Immunization Survey, reported at: http://www.cdc.gov/breastfeeding/data/NIS_data/index.htm.

  4. Source: National Household Survey on Drug Abuse, 2000. http://www.oas.samhsa.gov/nhsda/2kdetailedtabs/Vol_1_Part_4/sect6v1.htm#6.23b.

  5. These studies measured wantedness in different ways, but in all cases it is possible that the measures used reflect factors other than intended investment in the child (for example, Joyce and Grossman (1990) discuss the possibility that their measure may reflect, in part, the cost of contraception). In addition, wantedness may not be a fixed sentiment, but may vary over time, as discussed by Joyce et al. (2002).

  6. Results from supplemental analyses are not shown, but are available upon request.

  7. There were too few cases of no prenatal care (14) to analyze the effects of any prenatal care.

  8. Kimbro (2006) found that low-income women have substantial difficulty combining work and breastfeeding in the post-welfare reform era.

  9. Sample sizes were smaller than those in Table 1 when including telling stories, playing with toys, and hugging, which were assessed in only 18 of the 20 FFCWB cities. For the continuous regressions, the value varied from 0 to 7 days per week. For the dichotomous variables, we set the dependent variable equal to 1 if the mother engaged in the activities daily. These results are available upon request.

  10. We also estimated models that included the non-health related parenting measures on the right hand side in addition to all of the other covariates, as those factors might account for some of the potential unobserved heterogeneity across mothers vis-à-vis parenting and health behaviors. We found that including non-health related parenting behaviors affected the estimates of prenatal care on health-related parenting behaviors in only one case--when combining the former into a measure of activities that enhance the child's cognitive development (singing, telling stories, reading stories and playing with toys) and predicting four or more well-baby visits. In that case, the estimated effect of prenatal care became insignificant. However, we cannot rule out a scenario in which mothers are encouraged in the course of pediatric care to engage in those activities (reverse causality).

  11. To test for the possibility that proximity to hospital is an important choice variable rather than exogeneous source of prenatal care availability, we predicted distance to birth hospital as a function of the right-hand side variables from Table 2 (other than first trimester prenatal care) plus state indicators. The only variables that significantly predicted distance to hospital at conventional levels were the state indicators. These estimates suggest that proximity to a hospital is not an important factor in women’s residential location decisions.

  12. Currie and Reagan (2003) found that distance to hospital affects the use of pediatric care and Gray (2001) found that Medicaid fees affect early prenatal care.

  13. The Wald test of the hypothesis that rho = 0 yields chi-square statistics of .37 for smoking and .07 for well-baby visits, which are statistically insignificant. Thus, for these outcomes we cannot reject the null hypothesis of zero correlation between the error terms in the prenatal care and outcome equations.

  14. As an alternate specification, we estimated linear probability models, which produced results similar to those of the probit models.

  15. All bivariate probit estimates were insensitive to alternative identifiers (e.g., state Medicaid to Medicare fee ratios for obstetric services or Medicaid fees for vaginal deliveries instead of Medicaid eligibility thresholds). Data were obtained from Norton (1999).

References

  • Alexander, G., & Kotelchuck, M. (1996). Quantifying the adequacy of prenatal care: A comparison of indices. Public Health Reports, 111, 408–418.

    Google Scholar 

  • American Academy of Pediatrics. (2005). Policy statement: Breastfeeding and the use of human milk. Pediatrics, 115(2), 496–506.

    Article  Google Scholar 

  • American Academy of Pediatrics. (2008). Recommendations for pediatric health care. http://pediatrics.aappublications.org/cgi/data/120/6/1376/DC1/1.

  • Chay, K. Y., Guryan, J., & Mazumder, B. (2009). Birth cohort and the black-white achievement gap: The roles of access and health soon after birth. National Bureau of Economic Research working paper 15078.

  • Colman, G., Grossman, M., & Joyce, T. (2003). The effect of cigarette excise taxes on smoking before, during and after pregnancy. Journal of Health Economics, 22(6), 1053–1072.

    Article  Google Scholar 

  • Conway, K. S., & Kutinova, A. (2006). Maternal health: Does prenatal care make a difference? Health Economics, 15(5), 461–488.

    Article  Google Scholar 

  • Corman, H., Joyce, T. J., & Grossman, M. (1987). Birth outcome production function in the United States. Journal of Human Resources, 22(3), 339–360.

    Article  Google Scholar 

  • Currie, J., & Reagan, P. B. (2003). Distance to hospital and children’s use of preventive care: Is being closer better, and for whom? Economic Inquiry, 41(3), 378–391.

    Article  Google Scholar 

  • Dolan-Mullen, P., Ramirez, G., & Groff, J. Y. (1994). A meta-analysis of randomized trials of prenatal smoking cessation interventions. American Journal of Obstetrics and Gynecology, 171, 1328–1334.

    Google Scholar 

  • Evans, W. N., & Lien, D. S. (2005). The benefits of prenatal care: Evidence from the PAT bus strike. Journal of Econometrics, 125, 207–239.

    Article  Google Scholar 

  • Fang, W., Goldstein, A., Butzen, A., Hartsock, S., Hartmann, K., Helton, M., et al. (2004). Smoking cessation in pregnancy: A review of postpartum relapse prevention strategies. Journal of the American Board of Family Practice, 17, 264–275.

    Article  Google Scholar 

  • Freed, G., Clark, S., Pathman, D., & Schectman, R. (1998). Influences on the receipt of well-child visits in the first two years of life. Pediatrics, 103, 864–869.

    Google Scholar 

  • Gray, B. (2001). Do Medicaid physician fees for prenatal services affect birth outcomes? Journal of Health Economics, 20(4), 571–590.

    Article  Google Scholar 

  • Ip, S., Chung, M., Raman, G., Chew P., Magula, N., DeVine, D., et al. (2007). Breastfeeding and maternal and infant health outcomes in developed countries. Evidence report/technology assessment report 153, US Department of Health and Human Services, agency for healthcare research and quality; 2007. Available at http://www.ahrq.gov/downloads/pub/evidence/pdf/brfout/brfout.pdf.

  • Joyce, T. J., & Grossman, M. (1990). Pregnancy wantedness and the early initiation of prenatal care. Demography, 27(1), 1–17.

    Article  Google Scholar 

  • Joyce, T. J., Kaestner, R., & Korenman, S. (2002). On the validity of retrospective assessments of pregnancy intention. Demography, 39(1), 199–213.

    Article  Google Scholar 

  • Kimbro, R. T. (2006). On the job moms: Work and breastfeeding initiation and duration for a sample of low-income women. Maternal and Child Health Journal, 10(1), 19–26.

    Article  Google Scholar 

  • Kistin, N., Benton, D., Rao, S., & Sullivan, M. (1989). Breast-feeding rates among black urban low-income women: Effect of prenatal education. Pediatrics, 86, 741–746.

    Google Scholar 

  • Klesges, L. M., Johnson, K. C., Ward, K. D., & Bernard, M. (2001). Smoking cessation in pregnant women. Obstetrics and Gynecology Clinics of North America, 28, 269–282.

    Article  Google Scholar 

  • Kogan, M., Alexander, G., Jack, B., & Allen, M. (1998a). The association between adequacy of prenatal care utilization and subsequent pediatric care utilization in the United States. Pediatrics, 102, 25–30.

    Article  Google Scholar 

  • Kogan, M. D., Martin, J. A., Alexander, G. R., Kotelchuck, M., Ventura, S. J., & Frigoletto, F. D. (1998b). The changing pattern of prenatal care utilization in the United States, 1981–1995, using different prenatal care indices. Journal of the American Medical Association, 279, 1623–1628.

    Article  Google Scholar 

  • Lasser, K., Boyd, J. W., Woolhandler, S., Himmelstein, D. U., McCormick, D., & Bor, D. H. (2000). Smoking and mental illness a population-based prevalence study. Journal of the American Medical Association, 284(20), 2606–2610.

    Article  Google Scholar 

  • Lia-Hoagberg, B., Rode, P., Skovholt, C. J., Oberg, C. N., Berg, C., Mullett, S., et al. (1990). Barriers and motivators to prenatal care among low-income women. Social Science and Medicine, 30(4), 487–495.

    Article  Google Scholar 

  • Lu, M., Lange, L., Slusser, W., Hamilton, J., & Halfon, N. (2001). Provider encouragement of breast-feeding: Evidence from a national survey. Obstetrics and Gynecology, 97(2), 290–295.

    Article  Google Scholar 

  • Lu, M., Tache, V., Alexander, G., Kotelchuck, M., & Halfon, N. (2003). Preventing low birth weight: Is prenatal care the answer? Journal of Maternal and Fetal Neonatal Medicine, 13, 362–380.

    Google Scholar 

  • March of Dimes. (2009). During your pregnancy: Prenatal care. Pregnancy and newborn health education center. http://www.marchofdimes.com/pnhec/159_513.asp.

  • Martin, J. A., Hamilton, B. E., Sutton, P. D., Ventura, S. J., Menacker, F., & Kirmeyer, S. (2009). Births: Final data for 2006. National Vital Statistics Reports, 57(7). National center for health statistics. Available at: http://www.cdc.gov/nchs/data/nvsr/nvsr57/nvsr57_07.pdf.

  • Melvin, C., Dolan Mullen, P., Windsor, R. A., Whiteside, H. P., & Goldenberg, R. L. (2000). Recommended cessation counseling for pregnant women who smoke: A review of the evidence. Tob Control, 9, III80–III84.

    Google Scholar 

  • National Governors Association, Health Policy Studies Division, NGA Center for Best Practices. (1997). MCH Update: State Medicaid coverage of pregnant women and children. Available at: http://www.nga.org/cda/files/MCHUPDATE0997.pdf.

  • Norton, S. (1999). Recent trends in Medicaid physician fees 1993–1998. Urban institute discussion paper. Available at: http://www.urban.org/url.cfm?ID=409113.

  • Reichman, N. E., Corman, H., Noonan, K., & Dave, D. (2009). Infant health production functions: What a difference the data make. Health Economics, 18(7), 761–782.

    Article  Google Scholar 

  • Reichman, N. E., & Teitler, J. O. (2005). Timing of enhanced prenatal care and birth outcomes in New Jersey’s HealthStart program. Maternal and Child Health Journal, 9(2), 151–158.

    Article  Google Scholar 

  • Reichman, N. E., Teitler, J. O., Garfinkel, I., & McLanahan, S. (2001). Fragile families: Sample and design. Children and Youth Services Review, 23, 303–326.

    Article  Google Scholar 

  • Schappert, S. M. (1997). Ambulatory care visits to physician’s offices, hospital outpatient departments, and emergency departments: United States, 1996. Vital Health Stat, 13, 1–37.

    Google Scholar 

  • US Department of Health, Human Services. (1989). Caring for our future: The content of prenatal care, a report of the public health service expert panel on the content of prenatal care. Washington, DC: US Public Health Service, Dept of Health and Human Services.

    Google Scholar 

  • US Department of Health, Human Services. (2006). The health consequences of involuntary exposure to tobacco smoke: A report of the surgeon general. Atlanta Georgia: US Department of Health and Human Services, Centers for Disease Control and Prevention, Coordinating Center for Health Promotion National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health.

    Google Scholar 

  • Williams, L., Morrow, B., Shulman, H., Stephens, R., D’Angelo, D., & Fowler, C. I. (2006). PRAMS 2002 surveillance report. Atlanta, GA: Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention.

    Google Scholar 

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Acknowledgements

This research was supported by grants R03HD057230 and R01HD45630 from the National Institute of Child Health and Human Development. The authors are grateful to Shin-Yi Chou for helpful comments and Prisca Figaro for research assistance.

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Authors and Affiliations

  1. Department of Pediatrics, Robert Wood Johnson Medical School, University of Medicine and Dentistry of New Jersey, 97 Paterson St., Room 435, New Brunswick, NJ, 08903, USA

    Nancy E. Reichman

  2. Department of Economics, Rider University and National Bureau of Economic Research, 2083 Lawrenceville Rd., Lawrenceville, NJ, 08648, USA

    Hope Corman & Kelly Noonan

  3. School of Social Work, Columbia University, 1255 Amsterdam Avenue, New York, NY, 10027, USA

    Ofira Schwartz-Soicher

Authors
  1. Nancy E. Reichman
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  2. Hope Corman
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  3. Kelly Noonan
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  4. Ofira Schwartz-Soicher
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Correspondence to Kelly Noonan.

Appendix

Appendix

See Table 3.

Table 3 Bivariate probit models (N = 2,283)
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Reichman, N.E., Corman, H., Noonan, K. et al. Effects of prenatal care on maternal postpartum behaviors. Rev Econ Household 8, 171–197 (2010). https://doi.org/10.1007/s11150-009-9074-5

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