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  5. Healthy Pregnancies and Healthy Babies: Prenatal and Postpartum Care Interventions
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Healthy Pregnancies and Healthy Babies: Prenatal and Postpartum Care Interventions

Paper Session

Sunday, Jan. 7, 2024 8:00 AM - 10:00 AM (CST)

Convention Center, 225D
Hosted By: American Economic Association
  • Chair: Natalia Emanuel, Federal Reserve Bank of New York

Sins of Omission: The Cost of Avoiding Clinical Trials during Pregnancy

Alyssa Bilinski
,
Brown University
Natalia Emanuel
,
Federal Reserve Bank of New York

Abstract

Randomized controlled trials (RCTs) of drugs almost always exclude pregnant participants. While the intention is to insulate pregnant individuals from harmful side effects, this approach both slows drug uptake, which is costly when a drug is beneficial, and yet simultaneously requires more individuals to experience side effects before detection, which is costly when a drug is harmful. We develop a framework for comparing RCTs to observational trials both in terms of lives saved and fiscal costs.
We quantify the costs in life-years of avoiding RCTs with pregnant participants, both in terms of the expected a priori and observed value of information. Across studied indications, we estimate that avoiding clinical trials during pregnancy cost between $255 million and $1.8 billion. In each case, the expected value of information would have justified at least a $100 million trial.

Bridging the Postpartum Gap: A Randomized Controlled Trial Nudging Care Continuity for Patients at High Chronic Disease Risk

Mark A. Clapp
,
Massachusetts General Hospital
Alaka Ray
,
Massachusetts General Hospital
Kaitlin James
,
Massachusetts General Hospital
Jessica L. Cohen
,
Harvard T. H. Chan School of Public Health

Abstract

Over half of maternal deaths and a substantial share of maternal morbidity occur in the postpartum period. Although medical guidelines recommend that postpartum patients with chronic conditions and mental illness receive supported handoffs from their obstetrician to primary or specialty care, most patients do not effectively transition. We implemented a randomized controlled trial testing a behavioral economics inspired package of interventions to improve postpartum care transitions for pregnant patients at high risk for chronic disease. 360 patients with qualifying health conditions were recruited during pregnancy or within 14 days of delivery and randomized (within strata). We analyze the impact of the intervention on primary care utilization, screening and management of chronic diseases and mental illness, and emergency department use in the postpartum year.

The Impact of Intensive Nurse Home Visiting on Pregnancy, Childbirth and Postpartum Outcomes: Evidence from a Randomized Controlled Trial

Margaret McConnell
,
Harvard T. H. Chan School of Public Health
Katherine Baicker
,
University of Chicago

Abstract

Home visiting programs have received significant federal investment with the goal of improving maternal and child health outcomes. We evaluated the impact of the Nurse Family Partnership (NFP), an established nurse home visiting program. We conducted an individually randomized controlled trial of 5,670 eligible participants in South Carolina. Participants randomized to the treatment group were offered access to NFP; the control group had access to usual care. The primary outcome was a composite of low birthweight, small-for-gestational-age, or perinatal mortality. Secondary outcomes included other birth outcomes as well as prenatal and postnatal care utilization.

We found no statistically significant improvements in most outcomes examined among treatment vs. control group enrollees. There were no statistically significant improvements in the vulnerable or Black non-Hispanic subgroups despite stark racial disparities in birth outcomes. However, participants assigned to NFP were less likely to utilize care in the emergency department in the postpartum period. Subsequent work will examine NFP’s impact on child health, development, and the maternal life course.

ACA Medicaid Expansions and Provider Choice: Evidence from the Birth Certificate Records

Lauren Hoehn Velasco
,
Georgia State University
Sukriti Beniwal
,
Georgia State University

Abstract

This study considers the effect of the Affordable Care Act (ACA) Medicaid expansions on the utilization of healthcare providers. Using U.S. birth certificate records, we analyze the impact of the ACA Medicaid expansions on the trade-off between physicians and certified nurse-midwives (CNMs/CMs). Our findings indicate that the ACA Medicaid expansions led to an increase in the utilization of CNMs/CMs and a decrease in the reported deliveries by physicians. This shift from physicians to CNMs/CMs is particularly noticeable for low-risk deliveries, which are well-suited for CNM/CM care. These results suggest that ACA Medicaid expansions may have resulted in more appropriate sorting of low-risk patients into low-risk providers, particularly early in care.
JEL Classifications
  • I1 - Health