{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,4]],"date-time":"2026-10-04T18:52:32Z","timestamp":1791139952803,"version":"4.1.0"},"reference-count":49,"publisher":"American Medical Association (AMA)","issue":"9","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA Pediatr"],"published-print":{"date-parts":[[2023,9,1]]},"abstract":"Importance<\/jats:title>Home visiting is recommended to address maternal and infant health disparities but is underused with mixed impacts on birth outcomes. Community health workers, working with nurses and social workers in a combined model, may be a strategy to reach high-risk individuals, improve care and outcomes, and address inequities.<\/jats:p><\/jats:sec>Objective<\/jats:title>To assess the association of participation in a home visiting program provided by community health workers working with nurses and social workers (Strong Beginnings) with adverse birth outcomes and maternal care vs usual care among birthing individuals with Medicaid.<\/jats:p><\/jats:sec>Design, Setting, and Participants<\/jats:title>This retrospective, population-based, propensity score matching cohort study used an administrative linked database, including birth records and Medicaid claims, linked to program participation. The Strong Beginnings program exposure took place in 1 county that includes the second largest metropolitan area in Michigan. Study participants included primarily non-Hispanic Black and Hispanic Strong Beginnings participants and all mother-infant dyads with a Medicaid-insured birth in the other Michigan counties (2016 through 2019) as potential matching nonparticipants. The data were analyzed between 2021 and 2023.<\/jats:p><\/jats:sec>Exposure<\/jats:title>Participation in Strong Beginnings or usual care.<\/jats:p><\/jats:sec>Main Outcomes and Measures<\/jats:title>Preterm birth (less than 37 weeks\u2019 gestation at birth), very preterm birth (less than 32 weeks\u2019 gestation), low birth weight (less than 2500 g at birth), very low birth weight (less than 1500 g), adequate prenatal care, and postnatal care (3 weeks and 60 days).<\/jats:p><\/jats:sec>Results<\/jats:title>A total of 125\u202f252 linked Medicaid-eligible mother-infant dyads (mean age [SD], 26.6 [5.6] years; 27.1% non-Hispanic Black) were included in the analytical sample (1086 in Strong Beginnings [mean age (SD), 25.5 (5.8) years]; 124\u202f166 in usual prenatal care [mean age (SD), 26.6 (5.5) years]). Of the participants, 144 of 1086 (13.3%) in the SB group and 14\u202f984 of 124\u202f166 (12.1%) in the usual care group had a preterm birth. Compared with usual prenatal care, participation in the Strong Beginnings program was significantly associated with reduced risk of preterm birth (\u22122.2%; 95% CI, \u22124.1 to \u22120.3), very preterm birth (\u22121.2%; 95% CI, \u22122.0 to \u22120.4), very low birth weight (\u22120.8%; 95% CI, \u22121.3 to \u22120.3), and more prevalent adequate prenatal care (3.1%; 95% CI, 0.6-5.6), postpartum care in the first 3 weeks after birth (21%; 95% CI, 8.5-33.5]), and the first 60 days after birth (23.8%; 95% CI, 9.7-37.9]).<\/jats:p><\/jats:sec>Conclusions and Relevance<\/jats:title>Participation in a home visiting program provided by community health workers working with nurses and social workers, compared with usual care, was associated with reduced risk for adverse birth outcomes, improved prenatal and postnatal care, and reductions in disparities, among birthing individuals with Medicaid. 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Meulen","sequence":"additional","affiliation":[{"name":"Corewell Health, Healthier Communities Department, Strong Beginnings, Grand Rapids, Michigan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Celeste","family":"Sanchez Lloyd","sequence":"additional","affiliation":[{"name":"Corewell Health, Healthier Communities Department, Strong Beginnings, Grand Rapids, Michigan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lee Anne","family":"Roman","sequence":"additional","affiliation":[{"name":"Department of Obstetrics, Gynecology and Reproductive Biology, College of Human Medicine, Michigan State University, Grand Rapids and East Lansing"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"10","reference":[{"issue":"5","key":"poi230038r1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajog.2013.11.039","article-title":"Racial and ethnic disparities in severe maternal morbidity: a multistate analysis, 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