Perinatal & Pediatric
The Special Supplemental Nutrition Program for Women, Infants, and Children and Cerebral Palsy Risk Among Hispanic Mothers and Children in California Yunyue Shi* Yunyue Shi Haoran Zhuo Giselle Bellia Zeyan Liew
Cerebral Palsy (CP) is the most common childhood physical disability in the United States, affecting 2 to 3 per 1,000 children. While the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) has been associated with improved birth outcomes, the potential impact of WIC on CP risk is unclear, particularly among Hispanic groups. To estimate the effect of maternal use of WIC on offspring CP risk, we conducted a California statewide cohort study by analyzing birth records from 2007 to 2015 and CP diagnostic records from the Department of Developmental Services. Our analysis included 1,455,242 Hispanic mothers and their singleton births covered by Medi-Cal (California’s Medicaid program) who were eligible for enrollment in WIC. We performed logistic regression analysis to estimate the OR and 95% CI for CP associated with prenatal WIC use, adjusting for confounding factors. We used causal mediation analyses to examine the mediating roles of preterm birth and low birth weight. Overall, 91.2% of Hispanic mothers covered by Medi-Cal used WIC during pregnancy. WIC users were more likely to be younger, foreign-born, overweight or obese, have three or more children, and have lower education compared with non-users. Overall, a 20% lower odds of CP (OR=0.80, 95% CI: 0.68–0.93) was observed among the offspring of Hispanic mothers covered by Medi-Cal who used WIC compared with non-users. The estimated protective effect of WIC on CP was stronger among Hispanic mothers covered by Medi-Cal who had less than a high school education (OR=0.63, 95% CI: 0.50–0.80). Approximately 10–19% of the total association was estimated to be mediated through preterm birth or low birth weight. Our findings suggest that prenatal WIC use was associated with reduced CP risk in the offspring of Hispanic mothers with lower socioeconomic status. Maximizing WIC enrollment is recommended to benefit this vulnerable population for CP risk.