Effect of the Washington Special Supplemental Nutrition Program for Women, Infants and Children (WIC) on pregnancy outcomes.

OBJECTIVES: We determined the effect of the Washington State Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) on adverse pregnancy outcomes. METHODS: We used a record-linkage retrospective cohort design. We matched records of eligible women who enrolled in Washington WIC from 9/1/1999-12/31/2000 to records of their subsequent birth/fetal death from the Washington State Department of Health to determine their pregnancy outcome between 9/1/1999-10/15/2001 (N = 42,495). We selected comparison women from birth/fetal death records who were WIC-eligible but not on WIC (N = 30,751). We used unconditional logistic regression for analysis. RESULTS: WIC was protective for preterm delivery depending on history of abortion and adequacy of prenatal care, being most protective for women with abortion and inadequate prenatal care (Odds ratio (OR) = 0.4; 95% confidence interval (CI) = 0.3-0.5). WIC was protective for low birth weight depending on women's cervical health, with most protection conferred to those with incompetent cervix (OR = 0.2; 95% CI = 0.1-0.6). WIC was protective for fetal death depending on women's education, being most protective to those with <12 years of education (OR = 0.2; 95% CI = 0.1-0.3). CONCLUSIONS: WIC is protective for adverse pregnancy outcomes especially for high risk women.

A data driven process in Washington State to improve systems of care for children with special health care needs: the National Survey of CSHCN.

OBJECTIVES: The purpose of this article is to present strategies used in one state to engage public health stakeholders in the use of National Survey of Children With Special Health Care Needs (NS-CSHCN) results to improve systems of care for children with special health care needs (CSHCN). This is not a research report. METHODS: Seven "CSHCN Road Shows" were conducted with 39 local health departments, five state agencies, five parent leaders, three managed health care plans, and 12 school nurses. These "CSHCN Road Shows" were used to present and validate Washington State findings from the NS-CSHCN, obtain input on additional topics for analysis and elicit ways of incorporating NS-CSHCN results into the state's MCH Five Year Needs Assessment. RESULTS: Overall, a majority of stakeholders reported a high level of interest in using state-level data from the NS-CSHCN for local community efforts. Uses included program planning, presenting data to local boards of health and other community agencies, and utilizing results as talking points with other partners on the needs and unmet needs of the population. The state Title V office used feedback from "CSHCN Road Show" participants to prioritize program-planning activities, initiate policy discussions, and incorporate feedback into the MCH Five Year Needs Assessment. CONCLUSIONS: State-level data from the NS-CSHCN are a rich source of information for driving improvements in systems of care, facilitating state and local program planning efforts, writing grants, and completing MCH Five Year Needs Assessment activities.

Dental care use and self-reported dental problems in relation to pregnancy.

OBJECTIVES: We examined the relationships between risk factors amenable to intervention and the likelihood of dental care use during pregnancy. METHODS: We used data from the Washington State Department of Health's Pregnancy Risk Assessment Monitoring System. RESULTS: Of the women surveyed, 58% reported no dental care during their pregnancy. Among women with no dental problems, those not receiving dental care were at markedly increased risk of having received no counseling on oral health care, being overweight, and using tobacco. Among women who received dental care, those with dental problems were more likely to have lower incomes and Medicaid coverage than those without dental problems. CONCLUSIONS: There is a need for enhanced education and training of maternity care providers concerning oral health in pregnancy.