Abstract
Nearly 4 in 10 expectant mothers in the United States received Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) benefits during pregnancy between 2011 and 2017. Despite public support for the program, empirical evidence of the success of the program varies substantially. To assess the association of WIC program participation during pregnancy by low-income expectant mothers covered by Medicaid with infant mortality by gestational age at birth and by maternal race/ethnicity in comparison with their counterparts who did not receive WIC benefits. This cohort study obtained data from January 1, 2011, to December 31, 2017, from US live birth certificates. Data were from 11 148 261 expectant mothers who delivered live births in states that have implemented the 2003 revision of the US live birth certificate and whose insurance coverage and receipt of WIC benefits were recorded on the birth certificates. Data analysis was performed from June 2019 to October 2019. Receipt of WIC benefits during pregnancy. The first outcome was gestational age at birth: extremely preterm (<28 weeks), very preterm (28-32 weeks), moderate-to-late preterm (32-37 weeks), and normal term (≥37 weeks) births. The second outcome was death within the first year of life. Among the 11 148 261 expectant mothers who delivered live births between 2011 and 2017 and were covered by Medicaid during pregnancy, the modal age at delivery was 20 to 24 years, the predominant race/ethnicity was non-Hispanic white (4 257 790 [38.2%]), and 8 145 770 (73.1%) received WIC benefits during pregnancy. The proportion of expectant mothers covered by Medicaid who also received WIC benefits decreased from 2011 to 2017 (79.3% to 67.9%; P < .001). The odds of preterm birth compared with normal term birth were lower among expectant mothers covered by Medicaid who received WIC benefits during pregnancy compared with their counterparts who did not receive WIC benefits during pregnancy (adjusted proportional odds ratio, 0.87; 95% CI, 0.86-0.87). The odds of mortality within 1 year of birth were lower for infants whose mothers were covered by Medicaid and received WIC benefits during pregnancy compared with those who did not receive WIC benefits during pregnancy (adjusted odds ratio, 0.84; 95% CI, 0.83-0.86). This study found that receipt of WIC benefits among expectant mothers with Medicaid coverage was associated with lower risk of preterm birth and infant mortality.
Highlights
In 2018, the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) provided approximately 700 000 expectant mothers with checks or vouchers to purchase food to supplement their diets with specific nutrients.[1]
The odds of preterm birth compared with normal term birth were lower among expectant mothers covered by Medicaid who received WIC benefits during pregnancy compared with their counterparts who did not receive WIC benefits during pregnancy
The odds of mortality within 1 year of birth were lower for infants whose mothers were covered by Medicaid and received WIC benefits during pregnancy compared with those who did not receive WIC benefits during pregnancy
Summary
In 2018, the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) provided approximately 700 000 expectant mothers with checks or vouchers to purchase food to supplement their diets with specific nutrients (the mean monthly benefit was $40.96).[1] the WIC program receives widespread public support, empirical evidence of the success of the program varies substantially.[2,3] Numerous studies conclude that participation in the WIC program is associated with improved birth outcomes, such as higher birth weight, lower likelihood of neonatal intensive care unit admission, and lower Medicaid costs for newborns and mothers.[4,5,6,7,8,9,10,11] Other studies question these conclusions of success and commonly note 2 possible limitations.[12,13,14,15] First, some low-income women may be more able to participate in the WIC program because they are comparatively healthier or more well resourced compared with other low-income women (selection bias). Other studies found WIC participation to be associated with improved birth outcomes for low-income minority women, but either less or no association was found for low-income white women.[16,17]
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