MEDICAL YEAR IN REVIEW
The Potential Implications of Maternal Incarceration on Childbirth Outcomes: The State of Women in the American Prison System By Philip Whalen MS, OMS III; Chinazaekpele Nweke OMS III; Charley Meadows MS, OMS III; Josephine Sinamano MS, OMS III; Valentina Bustamante OMS III
Introduction As of 2016, there were 111,616 incarcerated women in the United States, and an estimated 6-10% were pregnant.1,2 The National Commission on Correctional Health Care (NCCHC) and the American Public Health Association (APHA) defined standards of care for incarcerated pregnant women. However, there is no agency that enforces these standards resulting in women receiving poor nutrition, lack of exercise, unsanitary living space and little or poor prenatal care.3 In this article, we will be examining the effects of maternal incarceration on childbirth outcomes by looking at three determinants of childbirth success, as well as the long-term effect on children’s mental health, to provide evidence for the need for strict regulation of adequate prenatal care for incarcerated women. The outcomes examined include birth weight, the incidence of preterm birth, and the fetal outcomes of infant mortality, miscarriage and abortion. Birth Weight Low birthweight is defined as a newborn weighing less than 5 pounds, 8 ounces or 2,500 grams. The average weight of a newborn child is roughly 8 pounds. While low birth weight may be associated with developmental abnormality, this isn’t necessarily a given as some underweight newborns do not have developmental abnormalities. Few studies concluded that incarceration during the first trimester led to decreased birth weight; however, this effect was minimal. In contrast, no correlation has been found in women initially incarcerated during the second and third trimester. This is exemplified by a two-year-long cross-sectional study of pregnant females incarcerated in Texas state prisons, that reported no children born with low birth weight born by mothers entering prison past 34-week gestation.6 Overall, studies demonstrated that there is no strong correlation between maternal incarceration and low birth weight.4 Kyei-Aboagye, K. et al. concluded that the prison environment, which provided limited access to controlled substances and adequate prenatal care improved fetal and maternal outcomes of expectant mothers. For example, they found that many women who admitted to smoking and/or using recreational drugs prior to going to prison had 26
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improvements in their child’s fetal birth weight and overall health.5 As a whole, this indicates that incarceration may actually prevent harmful and addictive behaviors that negatively impact mothers and children. Preterm Birth Preterm birth is defined as the birth of a fetus before 37 weeks gestation. According to the Center for Disease Control and Prevention (CDC), babies born prematurely are more likely to decease or suffer from respiratory problems, feeding issues, developmental sluggishness, vision problems, cerebral palsy or hearing problems.8 It has been speculated that maternal incarceration results in increased risk of preterm births. Shapiro-Mendoza et al.,9 stated that in the United States, preterm birth was the leading cause of death and morbidity of newborns. In 2013, preterm birth was responsible for about 36% of the 8,470 infant deaths. Some conditions seen in children born prematurely include necrotizing enterocolitis, intraventricular hemorrhage, decreased school performance, developmental sluggishness and respiratory distress syndrome. The risk factors found to increase preterm birth are advanced maternal age, low socioeconomic class, recreational drug and tobacco use, high or low Body Mass Index (BMI), multiple gestations, a previous preterm birth, pregnancy complications (placenta abruption, polyhydramnios, oligohydramnios), and maternal medical disorders (thyroid disease, asthma, etc.).9 Sufrin et al.1 conducted a study on pregnant women in prisons and found that out of 753 live births, 6% were preterm. In another study, Sufrin et al1 concluded that out of 224 pregnancies that occurred in jails, 64% resulted in live births, and of them 8% were preterm births.10 According to Shapiro-Mendoza et al., the risk of preterm birth could be minimized by increasing access to preconception care services to women of childbearing age ensuring that they enter pregnancy in peak health. They also highlighted the need for early identification of women who have an increased risk and providing them with additional prenatal care. For example, women with a history of preterm birth should be given 17 alpha-hydroxyprogesterone caproate which helps
