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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.

Objective: To evaluate the association between maternal reproductive history and preterm delivery., Methods: The 312 preterm delivery cases, studied in aggregate, and in subgroups (spontaneous preterm labor, preterm premature rupture of membranes, medically induced preterm delivery, moderate preterm delivery [gestational age at delivery 34-36 weeks], and very preterm delivery [gestational age at delivery <34 weeks]), were compared with 424 randomly selected women who delivered at term. Maternal medical records provided information on maternal reproductive history, pregnancy outcome, as well as sociodemographic characteristics. Using multivariate logistic regression, we derived maximum likelihood estimates of adjusted odds ratios (OR) and 95% confidence intervals (CI)., Results: A history of 2+ miscarriages was (OR = 2.2; 95% CI 1.2-3.9), but a history of 2+ prior induced abortions (OR = 1.2; 95% CI 0.7-2.0) was not, associated with preterm delivery in the index pregnancy. Analyses of preterm delivery subgroups indicated that a history of 2+ miscarriages was associated with an increased risk of spontaneous preterm labor (OR = 2.6; 95% CI 1.2-2.8), preterm premature rupture of membrane (OR = 1.8; 95% 0.7-4.4), and medically induced preterm delivery (OR = 1.9; 95% CI 0.8-4.2), though only the former approached statistical significance. Excess risk of preterm delivery was associated with maternal prior history of delivering a stillborn infant (OR = 10.7), a prior history of delivering a newborn that later died during the neonatal period (OR = 3.2), and a prior history of having a pregnancy complicated by spontaneous preterm delivery (OR = 6.0). Generally these associations were evident for each subgroup of preterm delivery, though inferences were often hindered by our relatively small sample size., Conclusions: These results support the hypothesis that maternal adverse reproductive history is associated with an increased risk of preterm labor and delivery.