Association of participation in a supplemental nutrition program with stillbirth by race, ethnicity, and maternal characteristics

• Type of Material: Article
• Authors: Meghan Angley, Emory University; Vanessa R. Thorsten, RTI International; Carolyn D Drews-Botsch, Emory University; Donald J. Dudley, University of Virginia; Robert L. Goldenberg, Columbia University; Robert M. Silver, University of Utah; Barbara Stoll, Emory University; Halit Pinar, Brown University; Carol J Hogue, Emory University
• Language: English
• Date: 2018-07-24
• Publisher: BMC (part of Springer Nature)
• Publication Version: Final Published Version
• Copyright Statement: © 2018 The Author(s).
• License: Creative Commons Attribution 4.0 International
• Final Published Version (URL): http://dx.doi.org/10.1186/s12884-018-1920-0
• Title of Journal or Parent Work: BMC Pregnancy and Childbirth
• ISSN: 1471-2393
• Volume: 18
• Issue: 1
• Start Page: 306
• End Page: 306
• Grant/Funding Information: This work was partially funded from Emory University’s Open Access Publishing Fund.; Funding did not support the analysis, interpretation or drafting of this manuscript.; The design of and data collection for the SCRN study was supported by grant funding from the Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, with supplemental funding from the Office of Research in Women’s Health, National Institutes of Health (grants U10- HD045953 (Brown University), U10-HD045925 (Emory University), U10-HD045952 (University of Texas Medical Branch at Galveston), U10-HD045955 (University of Texas Health Science Center at San Antonio), UK10-HD045944 (University of Utah Health Sciences Center), and U10-HD045954 (RTI International)).
• Keywords: IMPACT; Stillbirth; NEW-YORK-CITY; Obstetrics & Gynecology; Life Sciences & Biomedicine; SURVEILLANCE; PREGNANCY; WOMEN; Science & Technology; INFANTS; WIC; BIRTH OUTCOMES; AT-RISK APPROACH; Racial disparities; WIC PARTICIPATION
• Research Categories: Health Sciences, Obstetrics and Gynecology; Health Sciences, Epidemiology

Abstract

Background: Participation in the Special Supplemental Nutrition Program for Women, Infants and Children (WIC) has been associated with lower risk of stillbirth. We hypothesized that such an association would differ by race/ethnicity because of factors associated with WIC participation that confound the association. Methods: We conducted a secondary analysis of the Stillbirth Collaborative Research Network's population-based case-control study of stillbirths and live-born controls, enrolled at delivery between March 2006 and September 2008. Weighting accounted for study design and differential consent. Five nested models using multivariable logistic regression examined whether the WIC participation/stillbirth associations were attenuated after sequential adjustment for sociodemographic, health, healthcare, socioeconomic, and behavioral factors. Models also included an interaction term for race/ethnicity x WIC. Results: In the final model, WIC participation was associated with lower adjusted odds (aOR) of stillbirth among non-Hispanic Black women (aOR: 0.34; 95% CI 0.16, 0.72) but not among non-Hispanic White (aOR: 1.69; 95% CI: 0.89, 3.20) or Hispanic women (aOR: 0.91; 95% CI 0.52, 1.52). Conclusions: Contrary to our hypotheses, control for potential confounding factors did not explain disparate findings by race/ethnicity. Rather, WIC may be most beneficial to women with the greatest risk factors for stillbirth. WIC-eligible, higher-risk women who do not participate may be missing the potential health associated benefits afforded by WIC.