No abstract

(BJOG. 2018;125(11):1480–1487) Neonatal encephalopathy (NE) is characterized by abnormal neurological function that presents with decreased level of consciousness or seizures, difficulty maintaining respirations, and abnormal reflexes or tone. This clinical condition is identified shortly after birth with an incidence of 2 to 6/1000 live births. There is incomplete understanding of the etiology of NE and no evidence-based interventions to prevent its occurrence. The objective of the study was to identify predelivery fetal heart rate (FHR) characteristics associated with NE. The hypothesis was category III FHR tracings would be associated with NE.

INTRODUCTION: To assess the impact of improved access to contraception through Medicaid expansion (ME) on the rate of short interpregnancy intervals (IPIs) in the US. METHODS: Population-based retrospective cohort study using US live birth data of multiparous women with data on IPI in 2012 and 2016 (pre and post expansion in 2014). Rate differences of short IPI (<12 months) from 2012 to 2016 were compared between ME vs non-ME states. RESULTS: The rate of short IPI in the US was slightly lower in 2016 (17.3%) compared to 2012 (17.4%), p=0.0006; rate difference 0.13% (95% CI 0.05-0.20). Short IPIs occurred more frequently in non-ME states compared to ME states in both 2012 (18.08% vs 16.55%, p<.001) and 2016 (18.12% vs 16.44%, p<.001). The rate of short IPI decreased 0.11% (95% CI 0.01%-0.22%) in ME states vs increased 0.04% (95% CI 0.09-0.17) in non-ME states over the time period. CONCLUSION: The rate of short interpregnancy interval increased over time in non-expansion states but decreased in the states that adopted Medicaid expansion. If non-ME states had experienced the same rate of decrease in short IPI as ME states, 1122 fewer women would have experienced a short IPI in the US in 2016. Considering the known association between short IPI and adverse maternal and infant outcomes, these findings indicate Medicaid expansion could have an impact on improvement of perinatal outcomes in the US.

INTRODUCTION: Assess the effect of immediate access to postpartum (PP) LARCs (long-acting reversible contraceptives) and contraceptive access through Medicaid expansion (ME) on short interpregnancy interval (IPI) rates in the US. METHODS: Population-based retrospective cohort study of all US live births, 2016 (n=3,956,112), using Birth Certificate data. We categorized states into those that adopted Medicaid expansion (+ME), which improves access to PP contraception, and states that provide access to immediate PP-LARCs (https://www.acog.org/About-ACOG/ACOG-Departments/Long-Acting-Reversible-Contraception/Immediate-Postpartum-LARC-Medicaid-Reimbursement). States were classified as: (1) +ME/+LARC, (2) +ME/-LARC, (3) –ME/+LARC, (4) –ME/-LARC. Births from 13 states who adopted ME after 1/1/2014 were not included. Multivariate logistic regression estimated the relative influence of ME and PP-LARCs on the outcome of short IPI (<12 months), after adjusting for maternal race, age, marital status, and WIC. RESULTS: The study population comprised 1,831,665 births to multiparous women with data on IPI among included states. Of those, 50% were in 19 states with +ME/+LARC, 151,999 (8%) in 5 states with +ME/-LARC, 742,836 (40%) in 12 states with –ME/+LARC, and 3,876 (0.2%) in one state with –ME/-LARC. The rate/risk of short IPI was lowest in states with ME plus immediate PP-LARC access (16.17%, 95% CI 16.09-16.25%), adjusted RR 0.926, 95% CI 0.92-0.93). Short IPI rates and adjusted risks were slightly higher in states that adopted only one program or neither: +ME/-LARC 18.05% (CI 17.86-18.25%), -ME/+LARC 18.12% (CI 18.03-18.20%), -ME/-LARC 18.83% (CI 17.60-20.06%), with highest risk in the state with –ME/-LARC, adjRR 1.12, CI 1.05-1.19. CONCLUSION: These data demonstrate that both Medicaid expansion and access to immediate PP LARCs decrease the frequency of short IPI, which may reduce adverse birth outcomes in the US associated with insufficient birth spacing.

INTRODUCTION: To assess the influence of Medicaid on the rate of short interpregnancy intervals. We tested the hypothesis that Medicaid expansion and subsequent access to birth control would be associated with decreased short interpregnancy (IPIs) rates. METHODS: Using the US Birth Certificate data, we performed a population-based retrospective cohort study including all multiparous women who had a live birth in the US in 2016, after Medicaid expansion had been implemented. Multivariate logistic regression estimated the relative influence of Medicaid expansion on the outcome of short interpregnancy interval (<12 months). RESULTS: There were 3,956,112 live births in the US in 2016: 2,244,158 (56.7%) in multiparous women with data on IPI (n=1,077,411, 48% ME states, n=746,712, 33.3% non-ME states). The rate of short IPI was 18.1% in non-ME states compared to 16.4% in ME states, rate difference 1.68% (95% CI 1.57-1.79%). Living within a state that adopted ME was associated with a modestly decreased risk of a short interpregnancy interval (adjusted relative risk, 0.973; 95% CI 0.966-0.979), even after adjustment for coexisting risks for short IPI. The individual-level factors most strongly associated with short IPI in women who gave birth in states that did not adopt ME were black race, younger maternal age, unmarried, Medicaid enrollment and utilization of WIC, lack of early initiation of prenatal care initiation, and grand multiparity. CONCLUSION: The risk of short interpregnancy interval decreases with Medicaid expansion, even after adjusting for coexisting risk factors. This demonstrates the value of expanding Medicaid to women of child bearing ages.