But the policies that they engendered did not lead to the expected outcomes. Dubay and colleagues analyzed the Selleckchem AZD8055 effect of these expansions in the Medicaid program on access to prenatal care

and birth outcomes. After the expansions, more women enrolled in early and comprehensive prenatal care. But there was no decrease in the rate of low birth weight. The researchers concluded: “The emerging lesson from the Medicaid expansions, however, is that increased Inhibitors,research,lifescience,medical access to primary care is not adequate if the goal is to narrow the gap in newborn health between poor and non-poor populations.”16 Ray and colleagues studied the effect of Medicaid expansions in Tennessee. They concluded: “In Tennessee, the Medicaid Inhibitors,research,lifescience,medical expansions materially increased enrollment and use of prenatal care among high-risk women, but did not reduce the likelihood of preterm birth.”17 Kaestner,

in an analysis of national data, found little effect of the Medicaid expansions on birth outcomes and questioned the efficacy of these expansions.18 An insightful 1994 essay by Huntington and Connell suggested why. They pointed out that most of the earlier studies showing that prenatal care would be efficacious and cost-saving Inhibitors,research,lifescience,medical had serious methodologic flaws.19 In particular, they were confounded by selection bias which led to speculative estimates of the effectiveness of prenatal care in reducing low birth weight for women who would not typically have sought prenatal Inhibitors,research,lifescience,medical care. This led to underestimates of the true cost, and the true effectiveness, of comprehensive prenatal care for the highest-risk women, and an oversimplification of the relationship between prenatal care utilization, birth outcomes, and actual cost savings. As a result, they conclude: “The current public perception

of prenatal care oversimplifies the difficulties of delivering prenatal care to women who do not now receive it, overestimates the benefits of prenatal care, and contributes to the medicalization of complex Inhibitors,research,lifescience,medical social problems.” In response, researchers and practitioners developed and tested new and innovative ways to deliver more comprehensive prenatal care to the highest-risk women. They carried out randomized trials of different combinations of prenatal interventions. The programs included better social support, consultation with expert to nutritionists, smoking cessation programs, stress reduction, subsidized transportation to clinic, comprehensive screening for vaginal and cervical infections, and other interventions. The goal of these studies was to come up with the absolute ideal of comprehensive prenatal care for the women at highest risk for bad outcomes. In short, they tried to both define a new approach to prenatal care and propose that it become the standard of care. Eight such trials were summarized by Stevens-Simon in a 1999 meta-analysis. Overall, the trials enrolled nearly 10,000 pregnant women.