No abstract

Surveys of Food Intakes by Individualswere not specifically designed to study perinatal outcomes, we cannot evaluate the potentally negative impact of low energy intake on maternalweight gain, birthweight, and lactation performance. It is likely that, as has been noted for selfreported diets, our participants were underreporting their intakes of energy.9-10 It is also possible that their energy requirements were lower than the Recommended Dietary Allowance as a result of lower than average energy expenditure. The postpartum intakes of many nonlactating mothers did not return to prepregnancy levels, which may be a risk factor for retention of pregnancy weight gain.These findings are provocative and indicate a need for additional study of nationally representative samples to determine whether the maternal energy intakes observed here are associated with adverse effects on pregnancy outcome, lactational performance, and maintenance of desirable body weight. O

Since well-baby care use is similar for abused and nonabused mothers, pediatric practices may be important settings for screening women for violence.

BACKGROUND. Care coordination is an important component of the enhanced prenatal care services provided under the recent expansions of the Medicaid program. The effect of maternity care coordination services on birth outcomes in North Carolina was assessed by comparing women on Medicaid who did and did not receive these services. METHODS. Health program data files, including Medicaid claims paid for maternity care coordination, were linked to 1988 and 1989 live birth certificates. Simple comparisons of percentages and rates were supplemented by a logistic regression analysis. RESULTS. Among women on Medicaid who did not receive maternity care coordination services, the low birth weight rate was 21% higher, the very low birth weight rate was 62% higher, and the infant mortality rate was 23% higher than among women on Medicaid who did receive such services. It was estimated that, for each $1.00 spent on maternity care coordination, Medicaid saved $2.02 in medical costs for newborns up to 60 days of age. Among the women who did receive maternity care coordination, those receiving it for 3 or more months had better outcomes than those receiving it for less than 3 months. CONCLUSIONS: These results suggest that maternity care coordination can be effective in reducing low birth weight, infant mortality, and newborn medical care costs among babies born to women in poverty.

This study presents a standard methodology to identify children with specific health conditions and describe their medical care costs. Our example uses Medicaid claims and enrollment data to measure prevalence and costs among children who are medically fragile. This approach could be replicated for other health care payer data bases and also in other geographic areas.