Comparison of Common High-risk Pregnancy Conditions Between Health Start and Non-Health Start Participants

Abstract

Context: Health Start is a program run by the Arizona Department of Health Services (ADHS) that utilizes community health workers to educate at-risk pregnant women and new mothers throughout many of the underserved regions of Arizona. The Health Start Curriculum - the tool used to educate community health workers on prenatal and infant care - is currently undergoing a revision. This project is intended to examine medical risk factors and birth outcomes unique to Health Start participants in order to provide information that will be considered when revising the curriculum. Objective: To compare the prevalence of medical risk factors and selected birth outcomes of women actively enrolled in Health Start to their age-matched, race/ethnicity-matched, and delivery method-of-payment-matched counterparts. Methods: A cross-sectional study was conducted at the Arizona Department of Health Services Bureau of Women’s and Children’s Health using the birth certificate data from women who gave birth in Arizona in 2009. A relative risk for each medical risk factor and birth outcome parameter was tabulated using chi-square analysis, and the 5 statistical significance was determined utilizing a p-value of 0.05 as the cutoff for statistical significance. Results: Overall the study revealed a significantly lower rates of anemia in active Health Start participants compared to inactive Health Start enrollees (1.4% vs. 7.2%, p-value = 0.001). The low relative risk of pre-term delivery for Health Start participants compared to matched controls approached statistical significance (5.8% vs. 10.1%, p-value = 0.057), but the power of the test was limited due to small sample size. Other medical risk factors and birth outcomes did not reveal a statistically significant difference between active Health Start participants and matched controls or active Health Start Participants and inactive Health Start enrollees. Conclusions: Active enrollment in the Health Start program is associated with significantly lower rates of anemia and notably lower rates of pre-term delivery. A follow-up study with a larger sample size is indicated to increase the power of the study.