title: Reduced risk of low weight births among indigent women receiving care from nurse-midwives.
abstract: OBJECTIVE
  To examine the effect of a comprehensive prenatal and delivery programme administered by nurse-midwives on the risk of low weight births among indigent women.
  
  
  METHODS
  Historical prospective study. Birth outcomes among the cohort were compared with all county births during the same period, adjusting for maternal age and race. Results are expressed as relative risks with 95% confidence intervals.
  
  
  METHODS
  An enhanced Medicaid funded pre-natal programme administered by nurse-midwives from 1992 to 1994 in Westchester County, New York.
  
  
  METHODS
  Indigent mothers (n = 1443), between the ages of 15 and 44, who were residents of Westchester County and indicated having Medicaid or no health care coverage.
  
  
  RESULTS
  There were 1474 live births among cohort mothers. Mean (SD) gestational age was 39.4 (1.9) weeks. Less than 6% of births occurred before 37 weeks gestation. The mean birth weight of cohort infants was 3365.6 (518.6) g. Only 4.1% of the cohort births were less than 2500 g. Compared with all county births, the cohort showed a 41% reduction in the risk of low weight births (RRlbw = 0.59, 95% CI: 0.46 to 0.73, p < .001) and a 56% reduction when compared with county Medicaid births only (RR = 0.44, 95% CI: 0.34 to 0.57, p < .005) adjusting for maternal age and race. Larger reductions were found for very low weight births.
  
  
  CONCLUSIONS
  Mothers need not be considered at high risk for adverse pregnancy outcomes based on their socioeconomic status alone. Moreover, a comprehensive prenatal programme administered by nurse-midwives may promote a reduction in adverse pregnancy outcomes among indigent mothers.
authors.affiliation: Graduate School of Health Sciences, New York Medical College, Valhalla 10595, USA.
authors.forename: P F
authors.initials: PF
authors.lastname: Visintainer
authors.forename: J
authors.initials: J
authors.lastname: Uman
authors.forename: K
authors.initials: K
authors.lastname: Horgan
authors.forename: A
authors.initials: A
authors.lastname: Ibald
authors.forename: U
authors.initials: U
authors.lastname: Verma
authors.forename: N
authors.initials: N
authors.lastname: Tejani
mesh_terms: D000293:Adolescent; D000328:Adult; D001724:Birth Weight; D015331:Cohort Studies; D005260:Female; D006801:Humans; D007230:Infant, Low Birth Weight; D007231:Infant, Newborn; D008880:Midwifery / Q000458:organization & administration*; D009518:New York; D011247:Pregnancy; D011295:Prenatal Care / Q000458:organization & administration*; D011446:Prospective Studies; D018570:Risk Assessment; D012308:Risk Management; D012959:Socioeconomic Factors