title: Statewide Medicaid Enhanced Prenatal Care Programs and Infant Mortality.
abstract: OBJECTIVE
  To evaluate whether participation in a statewide enhanced prenatal and postnatal care program, the Maternal Infant Health Program (MIHP), reduced infant mortality risk.
  
  
  METHODS
  Data included birth and death records, Medicaid claims, and program participation. The study population consisted of Medicaid-insured singleton infants born between January 1, 2009, and December 31, 2012, in Michigan (n = 248 059). The MIHP participants were propensity score-matched with nonparticipants based on demographics, previous pregnancies, socioeconomic status, and chronic disease. Infant mortality, neonatal mortality, and postneonatal mortality analyses were presented by race.
  
  
  RESULTS
  Infants with any MIHP participation had reduced odds of death in the first year of life compared with matched nonparticipants (odds ratio [OR] 0.73, 95% confidence interval [CI] 0.63-0.84). Infant death odds were reduced both among black infants (OR 0.71, 95% CI 0.58-0.87) and infants of other races (OR 0.74, 95% CI 0.61-0.91). Neonatal death (OR 0.70, 95% CI 0.57-0.86) and postneonatal death odds (OR 0.78, 95% CI 0.63-0.96) were also reduced. Enrollment and screening in MIHP by the end of the second pregnancy trimester and at least 3 additional prenatal MIHP contacts reduced infant mortality odds further (OR 0.70, 95% CI 0.58-0.85; neonatal: OR 0.67, 95% CI 0.51-0.89; postneonatal: OR 0.74, 95% CI 0.56-0.98).
  
  
  CONCLUSIONS
  A state Medicaid-sponsored population-based home-visitation program can be a successful approach to reduce mortality risk in a diverse, disadvantaged population. A likely mechanism is the reduction in the risk of adverse birth outcomes, consistent with previous findings on the effects of the program.
authors.affiliation: Institute for Health Policy, Michigan State University; Department of Obstetrics, Gynecology, and Reproductive Biology, Michigan State University, East Lansing, Michigan; Babes-Bolyai University, Cluj-Napoca, Romania; cristian.meghea@hc.msu.edu.
authors.forename: Cristian I
authors.initials: CI
authors.lastname: Meghea
authors.affiliation: Institute for Health Policy, Michigan State University;
authors.forename: Zhiying
authors.initials: Z
authors.lastname: You
authors.affiliation: Department of Obstetrics, Gynecology, and Reproductive Biology, Michigan State University, East Lansing, Michigan;
authors.forename: Jennifer
authors.initials: J
authors.lastname: Raffo
authors.affiliation: Department of Obstetrics, Gynecology, and Reproductive Biology, Michigan State University, East Lansing, Michigan; Spectrum Health System, Grand Rapids, Michigan.
authors.forename: Richard E
authors.initials: RE
authors.lastname: Leach
authors.affiliation: Department of Obstetrics, Gynecology, and Reproductive Biology, Michigan State University, East Lansing, Michigan; Spectrum Health System, Grand Rapids, Michigan.
authors.forename: Lee Anne
authors.initials: LA
authors.lastname: Roman
mesh_terms: D000328:Adult; D006078:Government Programs / Q000592:standards; D006801:Humans; D007223:Infant; D007226:Infant Mortality / Q000639:trends*; D007229:Infant Welfare; D008429:Maternal Welfare; D008484:Medicaid; D008824:Michigan; D011181:Postnatal Care / Q000592:standards*; D011295:Prenatal Care / Q000592:standards*; D058996:Quality Improvement; D014481:United States; D055815:Young Adult