Association between insurance type and pregnancy outcomes in women diagnosed with hypertensive disorders of pregnancy

Greiner, Karen S.; Speranza, Rosa; Rincón, Mónica; Beeraka, Sridivya S.; Burwick, Richard M.

doi:10.1080/14767058.2018.1519544

Cited by 24 publications

(20 citation statements)

References 30 publications

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“…Other literature investigating disparities in maternal morbidity by insurance status has been largely limited to comparisons between Medicaid versus privately insured women. The results of the study support the need to focus on the broader range of insurance types (Brandon et al, 2009 ; Greiner et al, 2018 ; Fingar et al, 2018 ; Lipkind et al, 2009 ).…”

Section: Discussionsupporting

confidence: 65%

Risk Factors for Dual Burden of Severe Maternal Morbidity and Preterm Birth by Insurance Type in California

Ayadi

Baer

Gay

et al. 2022

Matern Child Health J

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Objectives Among childbearing women, insurance coverage determines degree of access to preventive and emergency care for maternal and infant health. Maternal-infant dyads with dual burden of severe maternal morbidity and preterm birth experience high physical and psychological morbidity, and the risk of dual burden varies by insurance type. We examined whether sociodemographic and perinatal risk factors of dual burden differed by insurance type. Methods We estimated relative risks of dual burden by maternal sociodemographic and perinatal characteristics in the 2007–2012 California birth cohort dataset stratified by insurance type and compared effects across insurance types using Wald Z-statistics. Results Dual burden ranged from 0.36% of privately insured births to 0.41% of uninsured births. Obstetric comorbidities, multiple gestation, parity, and birth mode conferred the largest risks across all insurance types, but effect magnitude differed. The adjusted relative risk of dual burden associated with preeclampsia superimposed on preexisting hypertension ranged from 9.1 (95% CI 7.6–10.9) for privately insured to 15.9 (95% CI 9.1–27.6) among uninsured. The adjusted relative risk of dual burden associated with cesarean birth ranged from 3.1 (95% CI 2.7–3.5) for women with Medi-Cal to 5.4 (95% CI 3.5–8.2) for women with other insurance among primiparas, and 7.0 (95% CI 6.0–8.3) to 19.4 (95% CI 10.3–36.3), respectively, among multiparas. Conclusions Risk factors of dual burden differed by insurance type across sociodemographic and perinatal factors, suggesting that care quality may differ by insurance type. Attention to peripartum care access and care quality provided by insurance type is needed to improve maternal and neonatal health.

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Section: Discussionsupporting

confidence: 65%

Risk Factors for Dual Burden of Severe Maternal Morbidity and Preterm Birth by Insurance Type in California

Ayadi

Baer

Gay

et al. 2022

Matern Child Health J

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“…As reported in previous studies, severe ICP as well as preeclampsia are risk factors of AFOs 19,20 , including preterm delivery, low birth weight, NICU admission, and stillbirth 12,21 . This study found that both planned and unplanned CD cases had increased fetal complications compared to vaginal delivery in ICP patients.…”

Section: Discussionmentioning

confidence: 54%

Influence of severity of total bile acids and mode of delivery on the perinatal outcomes in intrahepatic cholestasis of pregnancy

Kong

Mei

Xue

et al. 2021

Preprint

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To assess the associations between mode of delivery and pregnancy outcomes in patients with intrahepatic cholestasis of pregnancy (ICP) based on the severity of maternal hypercholanemia. A hospital-based retrospective cohort study was performed between January 1, 2015, and December 31, 2019. Among the 177 women with mild total bile acids, 123 (69.5%) had a vaginal delivery and 54 (30.5%) underwent a cesarean delivery, of which 42 (23.7%) were planned and 12 (6.8%) were unplanned. Among the 50 severe ICP women, 13 (26.0%) had a vaginal delivery and 37 (74.0%) underwent a cesarean delivery, of which 26 (52.0%) were planned and 11 (22.0%) were unplanned. Severe ICP was associated with an increased risk of preterm delivery (P < 0.001), low birthweight (P=0.001), and neonatal intensive care unit admission (P < 0.001). Women with severe ICP (aOR, 5.017; 95% CI 1.848–13.622), planned cesarean delivery (aOR, 5.444; 95%CI 1.723–17.203), or unplanned cesarean delivery (aOR, 5.792; 95%CI 1.384–24.236) had increased risks of adverse fetal outcomes compared to controls. Both planned and unplanned cesarean delivery are associated with a higher incidence of adverse fetal outcomes and severe ICP than vaginal delivery.

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“…This cross-sectional study on PRAMS data in 26 states found a linear and positive relationship between dental visits during pregnancy and state Medicaid dental coverage for adult pregnant women. Enrollment in Medicaid itself was shown to be a predictor for low health care utilization and poor health outcomes [43][44][45][46][47] as Medicaid beneficiaries share key sociodemographic factors that may impact access to health services. However, Medicaid-enrolled pregnant women may face more significant barriers to accessing dental care.…”

Section: Discussionmentioning

confidence: 99%

Dental care utilization during pregnancy by Medicaid dental coverage in 26 states: Pregnancy risk assessment monitoring system 2014–2015

Lee

Marsteller

2021

J Public Health Dent

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Objective: To examine the association between Medicaid dental coverage for adult pregnant women with dental care utilization during pregnancy. Methods: Pregnancy risk assessment monitoring system (PRAMS) data (2014)(2015) and the Medicaid-SCHIP state dental association (MSDA) national profiles (2014)(2015) were used in this study. The study sample included 16,612 Medicaid-enrolled women, for a weighted number of 965,046 women from 26 states and New York City. State Medicaid dental coverage was categorized into (1) no coverage for the dental cleaning, (2) coverage for dental cleaning and fillings, (3) extended dental coverage. The adjusted prevalence ratios (aPR) for dental visits for cleaning during pregnancy were examined by Medicaid dental coverage level. Results: Medicaid-enrolled women in states with no dental coverage were less likely to visit dentists for cleaning during pregnancy (26.7%) compared with women in states with either limited dental coverage (36.6%) or extended dental coverage (44.9%). Compared with women in state without dental coverage, Medicaid-enrolled women in states with extended dental coverage (aPR = 1.20, 95% ) and women in states with limited coverage (aPR = 1.10, 95% CI [1.06-1.14]) were more likely to visit dentists for cleaning during pregnancy when adjusted for other sociodemographic variables and adequacy of prenatal care. A similar pattern of association was observed for a dental visit to address dental problems during pregnancy. Conclusions: This study highlights the importance of Medicaid dental coverage for adult pregnant women related to dental service utilization during pregnancy.

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Association between insurance type and pregnancy outcomes in women diagnosed with hypertensive disorders of pregnancy

Cited by 24 publications

References 30 publications

Risk Factors for Dual Burden of Severe Maternal Morbidity and Preterm Birth by Insurance Type in California

Risk Factors for Dual Burden of Severe Maternal Morbidity and Preterm Birth by Insurance Type in California

Influence of severity of total bile acids and mode of delivery on the perinatal outcomes in intrahepatic cholestasis of pregnancy

Dental care utilization during pregnancy by Medicaid dental coverage in 26 states: Pregnancy risk assessment monitoring system 2014–2015

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