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					                           Differential Rates of Birth Defects in Florida Among Infants
                                    Born to Poverty and Non Poverty Women
                                                         Jeffrey       Douglas
                                                                            Roth a,      Randy            Mario         Michael B.
                                                                                                                               Grove b,                                  Carter b,                                       Ariet c,                                                 Resnicka
                                                               aDepartment of Pediatrics, bStatistics, cMedicine, University Of Florida

                CONTEXT                                           OUTCOME MEASURE                                                                                                                                                                                                       RESULTS
 The risk of delivering an infant with a birth defect                                                                                              Table 1. Birth Defect Rates Per Ten Thousand in Children Up to 1 year                                                                        Infants of women who were in poverty during pregnancy had
                                                            FBDR groups the National Birth Defects
  is elevated for women living in poverty because of                                                                                                of age, born to 2 Groups of Pregnant Women, Florida 1998                                                                                      elevated risks of Central Nervous System, Chromosomal,
                                                             Prevention Network (NBDPN) Reporting List
  the association between low socioeconomic status                                                                                                                                                                                                                                                Gastrointestinal, Heart, and Musculoskeletal defects
                                                             of 45 major birth defects (defined by one or
  and exposure to potentially harmful substances                                                                                                                                                                                    Income Level of Mother                                       The risk of Central Nervous System defects was 80% higher
                                                             more ICD-9 codes) into 8 categories
  such as hazardous waste, industrial contaminants,
                                                            The birth defect must have been diagnosed,                                                Birth Defect Category                                                       Poverty    Non-Poverty                                         among infants born to women in poverty compared to women not
  pesticides, and illicit drugs                                                                                                                                                                                                                                                                   in poverty
                                                             or signs or symptoms recognized, within the                                                CNS (Central Nervous System)                                                    27.7            14.3
 In Florida women in poverty qualify for                                                                                                                                                                                                                                                        Male infants had significantly lower risk of chromosomal and
  pregnancy-related services through Medicaid.
                                                             child’s first year of life                                                                 CHROMO (Chromosomal)                                                            16.3            14.6
                                                                                                                                                        GI (Gastrointestinal)                                                           34.6            24.8                                      musculoskeletal defects than female infants
  Compared to women not eligible for Medicaid,
  pregnant women supported by Medicaid                                                                                                                  GU (Genital and Urinary)                                                        58.3            62.6                                     Women 35 and older had nearly four times the risk of delivering a
                                                                                                                                                                                                                                                                                                  child with a chromosomal defect as women 20-34. Maternal age
  consistently have exhibited over the last five
  years shorter interpregnancy intervals, higher risk
                                                                                   METHODS                                                              HEART
                                                                                                                                                        MUSC (Musculoskeletal)
                                                                                                                                                                                                                                                                                                  >34 was also associated with elevated risks for 3 other categories
  scores on the Healthy Start prenatal screening            Counts and rates were generated by SAS                                                                                                                                                                                               of birth defects
                                                                                                                                                        ORAL                                                                            17.3            11.6                                     Smoking, drinking, single marital status, and maternal age >34
  instrument, lower rates of entry into first                PROC FREQ from the FBDR
                                                            Generalized linear models, with number of                                                  OTHER                                                                           10.0             4.1                                      more than doubled the risk of having an infant with an Other birth
  trimester prenatal care, more births to women
  under 18, and higher rates of preterm birth and            children with birth defects as the response                                                OVERALL                                                                        336.0           277.0                                      defect (a category combining several low frequency anomalies of
  low birth weight                                           variable and a log link function, were fitted                                                                                                                                                                                        the eye, ear, or face)
                                                             using the GENMOD Procedure of SAS. This                                                  The rate of birth defects among infants born to poverty women was higher than

                                                             method modeled the log of the probability
                                                             of being classified into a birth defect
                                                                                                                                                       that of infants born to non poverty women in seven of the eight major categories
                                                                                                                                                      Overall, the raw rate of birth defects among infants born to poverty women was
                                                             category as a linear function of socio-                                                   20% higher than that of non-poverty women (3.4 vs. 2.8)                                                                                   Poverty appears to be associated with five of the eight major birth
 To compare the prevalence of birth defects                  demographic and medical variables                                                                                                                                                                                                    defect categories even when the effects of 12 potentially
 among two groups of pregnant women: Poverty,
                                                                                                                                                                                                                                                                                                  confounding sociodemographic and medical risk factors are taken
 defined as those who received either Medicaid or
                                                             Table 2. Significant Relative Risks (and 99% Confidence Intervals) of 12 Medical and Sociodemographic Risk Factors for 8 Birth Defects Categories                                                                                    into account statistically
 WIC during pregnancy; and Non-Poverty defined
 as those who were not eligible for either                       Birth            Pregnancy      Plurality        Infant Sex-        Adverse          Smoking        Drinking            Poverty            Inadequate    Stress Level        Single          Maternal           Maternal        Birth defects prevention and education programs need to especially
 program because their family income exceeded                    Defect           Interval                        Male               Previous         During         During                                 Prenatal      >1                  Marital         Race-Black         Age >34          target low income women who are likely to receive Medicaid or WIC
                                                                 Category         <15 mos.                                           Pregnancy        Pregnancy      Pregnancy                              Care                              Status
 185% of the federal poverty level.                                                                                                  Experience                                                                                                                                                   services when they become pregnant
                                                                 CNS                             2.05                                                                                    1.80                             1.63                                1.93

                                                                                                 (1.18, 3.57)                                                                            (1.03, 3.15)                     (1.09, 2.45)                        (1.39, 2.67)

                                                                 CHROMO                                           .71                                                                    1.47                                                                                    3.81
                                                                                                                  (.54, .95)                                                             (1.05, 2.04)                                                                            (2.74, 5.31)
                                                                 GI                                               2.49                                                                   1.68                                                                 .53                1.771
 Study population was the set of 195,344 children born in                                                        (1.96,3.16)                                                            (1.32, 2.13)                                                         (.39, .73)         (1.10, 2.86)
  1998 to Florida residents                                      GU                                               6.72                                                                                      .71                                                                                 The authors thank Jane Correia, Karen Freeman, Carol Graham,
 Birth defects were diagnosed in 5,986 children or 3.1%
                                                                                                                  (3.36, 13.23)                                                                             (.53, .96)                                                                          Meade Grigg, Michael Haney, Alan Rowan, Rhonda White, Florida
                                                                 HEART            1.943                                              1.27                                                1.24                                                                 1.22               1.32
  of the study population                                                         (1.17, 3.22)                                       (1.08, 1.51)                                        (1.11, 1.38)                                                         (1.08, 1.37)       (1.16, 1.50)   Department of Health; Ed Feaver, Dick Lasko, Charles Mahan,
 Data were drawn from surveillance of live births by            MUSC                                             .57                                                                    1.52                                                                 .59                               Chiles Center for Healthy Mothers and Babies, University of South
                                                                                                                  (.45, .72)                                                             (1.20, 1.93)                                                         (.43, .82)
  Florida Birth Defects Registry (FBDR)                          ORAL                                                                                                                                                     2.15
                                                                                                                                                                                                                                                                                                Florida; Susan Chen, Nancy Ross, Florida Agency for Health Care
 Sources of data were: Office of Vital Statistics birth                                                                                                                                                                  (1.30, 3.56)                                                          Administration; Perry Brown, Jaime Frías, Kim Hauser, Charles
                                                                 OTHER                                                                                2.394          2.87                                                                     2.43                               2.22
  certificates, Children's Medical Services (CMS) Regional                                                                                            (1.06, 5.41)   (1.61, 5.11)                                                             (1.50, 3.95)                       (1.25, 3.94)
                                                                                                                                                                                                                                                                                                Williams, Florida Birth Defects Registry University Consortium for
  Perinatal Intensive Care Centers Data Reporting System,                                                                                                                                                                                                                                       their assistance, cooperation, and advice.
  CMS Early Intervention Program Data Report System,
                                                                 Sig. Interaction with Inadequate Prenatal Care      2
                                                                                                                         Sig. Interaction with Maternal Race-Black             3
                                                                                                                                                                                   Sig. Interaction with Plurality                   4
                                                                                                                                                                                                                                         Sig. Interaction with Maternal Age>34                  This research was supported by funds provided by the Florida
  CMS Minimum Data Set, the Florida Agency for Health                Twelve medical and sociodemographic/behavioral risk factors were found to have either adverse or protective effects in the 8 major                                                                                        Agency for Health Care Administration and Department of Health.
  Care Administration (AHCA) hospital discharge data and              birth defect categories                                                                                                                                                                                                   Its contents are solely the responsibility of the authors and do not
  AHCA Medicaid eligibility files                                                                                                                                                                                                                                                               represent the official views of either agency.
                                                                     Poverty was a significant factor in five of the eight major birth defect categories after the effects of potentially confounding medical
                                                                      and sociodemographic variables were controlled statistically

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