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Associations between introduction and withdrawal of a financial incentive and timing of attendance for antenatal care and incidence of small for gestational age: Natural experimental evaluation using interrupted time series methods

Lookup NU author(s): Dr Zelda Van Der Waal, Professor Stephen Rushton, Professor Judith Rankin

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Abstract

© 2018 Wolters Kluwer Health, Inc. All rights reserved. The Health in Pregnancy Grant (HiPG), introduced April 2009, was a one-time payment of 190£ payable to all pregnant women residing in the United Kingdom after the 25th week of gestation, contingent on them receiving routine antenatal care. The HiPG was withdrawn after a 2010 general election, and women were only able to claim the payment if they reached the 25th week of pregnancy before January 1, 2011. National guidance recommends the first antenatal visit to occur at the latest by the 18th week of gestation; however, women living in more deprived circumstances often undergo this visit later. This experimental, interrupted time series study aimed to determine if the introduction and withdrawal of the HiPG was associated with a change in the timing of the first antenatal visit or small for gestational age (SGA) birth outcome. Data were gathered in 2015 from a tertiary hospital in Northern England. Participants included women who completed the 25th week of pregnancy in the 75 months before HiPG introduction, 21 months during HiPG availability, and 36 months after withdrawal of the HiPG. The primary study outcome was mean gestational age at booking of the first antenatal care appointment. Changes in mean gestational age at booking were calculated using counterfactual data generated using trends before introduction of the HiPG. The 2 secondary outcomes were the proportion of women booking by 10, 18, and 25 weeks of gestation, and the proportion of babies that were SGA. A total of 34,589 women delivered at the study hospital and completed the 25th week of gestation between January 2003 and December 2013. Introduction of the HiPG was associated with both a reduction in the mean gestational age at booking and an improvement in the trend of timing of booking and proportion booking by 10, 18, and 25 weeks. Twenty-one months after introduction of the HiPG, there was a 4.8-day reduction in the mean gestational age at booking (95% confidence interval [CI], 2.3-8.2), a 2.2% increase in the proportion of women booking by 18 weeks (95% CI, 1.2-3.9), and a 1.9% increase in the proportion of women booking by 25 weeks (95% CI, 0.6-3.5).Withdrawal of the HiPG was associated with a change in the trend toward delay in mean gestational age at booking and the proportion booking by 10 and 18 weeks declined. Twentyfour months after withdrawal of the HiPG, there was a 14.0-day increase in the mean gestational age at booking (95% CI, 2.8-16.8). The introduction and withdrawal of the HiPG was not associated with a change in the prevalence of SGA births. The data shows that a universal financial incentive for timely antenatal care is associated with a decrease inmean gestational age at first visit and a higher proportion achieving prenatal care initiation by 10, 18, and 25 weeks' gestation. However, this change was not associated with a similar change in the prevalence of SGA births.


Publication metadata

Author(s): Adams J, Van Der Waal Z, Rushton S, Rankin J

Publication type: Note

Publication status: Published

Journal: Obstetrical and Gynecological Survey

Year: 2018

Volume: 73

Issue: 6

Pages: 329-330

Online publication date: 01/06/2018

Acceptance date: 02/04/2018

ISSN (print): 0029-7828

ISSN (electronic): 1533-9866

Publisher: Lippincott Williams and Wilkins

URL: https://doi.org/10.1097/01.ogx.0000540054.55141.4d

DOI: 10.1097/01.ogx.0000540054.55141.4d


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