Underinsured Women May Miss Important Pregnancy Care

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Gaps in health insurance coverage before, during and after pregnancy are particularly common among low-income women.

And for this group of patients, these unsubscribes may reduce the likelihood that they will receive antenatal care during their first trimester or postpartum visits compared to those with stable insurance, a new study by Michigan Medicine in JAMA network open suggests.

“Our results show that insurance disruptions are associated with lower levels of recommended pregnancy-related care,” says lead author Lindsay Admon, MD, M.Sc., obstetrician-gynecologist and researcher at Michigan Medicine Von Voigtlander Women’s Hospital.

“This suggests that insurance instability may contribute to the alarming disparities we have observed in maternal and child health outcomes.”

Spanish-speaking and Spanish-speaking women made up almost two-thirds of women without permanent insurance, suggesting particularly high barriers to enrollment among this population potentially associated with immigration status, Admon says.

The researchers analyzed data between 2015 and 2017 that included a nationally representative sample of 39,378 women with an average age of 27. Of these, around 44% were insured continuously. 21% have seen changes between private and Medicaid coverage and 32% have seen changes between insurance and uninsured. Just over 2% were continuously uninsured.

Maternal care essential for results

Pregnant patients who do not receive antenatal care have a higher risk of unwanted outcomes for babies, including low birth weight or death, Admon says. Regular maternal care also gives providers the opportunity to identify underlying health problems that can negatively affect the health of a mother or baby. This includes pre-existing conditions, such as heart disease and high blood pressure, which are among the leading causes of maternal morbidity and mortality.

Postpartum care is also essential for identifying serious and even fatal health complications that can occur days or weeks after childbirth. This can include cardiovascular disease, infection, or high blood pressure, among other health issues.

The new research follows an earlier study by Admon and colleagues showing less insurance disruption among low-income pregnant patients in states with expansion of Medicaid by the Affordable Care Act. The policy improved the continuity of perinatal insurance for low-income women, the authors concluded.

National efforts to extend Medicaid through the first year of postpartum are also supported by the American Medical Association, another strategy to improve access to health care for postpartum women, researchers say. .

“Antenatal and postpartum care is essential for keeping mothers and babies healthy,” says Admon. “We need to do more work to ensure that all women – regardless of race, ethnicity or income – have adequate maternal care coverage at every stage of pregnancy, starting before conception and continuing after pregnancy. ‘childbirth. “

Cited article: “Insurance Coverage and Perinatal Health Care Utilization Among Low-Income Women in the United States, 2015-2017”, JAMA network open. DOI: 10.1001 / jamanetworkopen.2020.34549


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