Maternal substance abuse: Impact of prenatal care on newborn outcomes and costs.
Item
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Title
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Maternal substance abuse: Impact of prenatal care on newborn outcomes and costs.
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Identifier
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AAI9830762
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identifier
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9830762
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Creator
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Simantov, Elisabeth.
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Contributor
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Adviser: Theodore J. Joyce
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Date
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1998
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Language
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English
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Publisher
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City University of New York.
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Subject
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Economics, General | Health Sciences, Public Health | Sociology, Individual and Family Studies | Women's Studies
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Abstract
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The impact of prenatal care on newborn birth weight, costs, and hospital length of stay associated with exposure to illicit drugs was examined in a multivariate context. The data set contains over 75,000 mother/infant pairs that were generated from a linkage of birth certificates and hospital discharge records. The study population consisted of low income, urban women who delivered an infant in any of the 11 municipal hospital in New York City during the years 1990-1992. The information on the use of illicit drugs during pregnancy was based on ICD-9 codes from discharge abstracts and indicators from birth certificates. The underlying economic model is one in which infant health is produced by a variety of prenatal and neonatal inputs. Prenatal care was measured by the Kotelchuck APNCU index, modified by the addition of two categories--women who received no prenatal care and women with unknown care.;Separate estimates of the effect of prenatal care on outcomes mentioned above were obtained for infants who were identified as prenatally exposed to illicit drugs and for infants classified as unexposed. The analyses revealed that prenatal care was associated with a greater reduction in newborn costs and a greater increase in birth weight among drug-exposed infants than among unexposed infants. The marginal benefits of prenatal care were largest for exposed infants whose mothers obtained inadequate care, as defined by the APNCU index, compared with no care. Higher levels of care were not associated with improved outcomes. The receipt of adequate plus care was generally an indication of a high-risk pregnancy. The impact of prenatal care on outcomes of unexposed infants was modest and primarily operated through decreased incidence of low birth weight. Despite the larger effects of prenatal care in the sample of substance abusers, the impact of prenatal care on newborn costs was small compared to the costs associated with exposure to illicit drugs. These findings suggest that further improvements in newborn outcomes and costs seem unlikely without the treatment of addiction itself.
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Type
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dissertation
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Source
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PQT Legacy CUNY.xlsx
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degree
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Ph.D.
