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Preconception insurance and initiation of prenatal care
Mark A Clapp1,2, Kaitlyn E James3, Anjali J Kaimal4,5
1Department of Obstetrics and Gynecology, Massachusetts General Hospital, Boston, MA, USA. mark.clapp@mgh.harvard.edu.
Insights
Preconception insurance significantly increases the likelihood of early prenatal care initiation. Uninsured women face delays in starting prenatal care and experience higher risks for preterm birth and small for gestational age infants.
Area of Science:
- Reproductive Health
- Health Services Research
- Maternal and Child Health
Background:
- Access to health insurance before conception is crucial for maternal health.
- Timely initiation of prenatal care is a key indicator of positive pregnancy outcomes.
- Disparities in insurance coverage can impact healthcare access and utilization.
Purpose of the Study:
- To examine the association between preconception insurance status and the initiation of prenatal care.
- To investigate the relationship between preconception insurance and secondary pregnancy outcomes, including preterm delivery, birth weight, and birth defects.
Main Methods:
- Retrospective cohort study utilizing data from the Pregnancy Risk Assessment Monitoring System (2009-2013).
- Self-reported preconception insurance status as the primary exposure variable.
- Survey-weighted generalized linear models were employed to calculate adjusted relative risks, accounting for state-level clustering.
Main Results:
- A significant association was found between preconception insurance and first-trimester initiation of prenatal care (adjusted RR 0.87; 95% CI 0.85-0.89).
- Uninsured women were less likely to initiate prenatal care in the first trimester compared to insured women (88% vs. 70%).
- Uninsured nulliparous women had a higher risk of extremely preterm delivery (adjusted RR 1.20; 95% CI 1.03-1.39) and delivering a small for gestational age infant (adjusted RR 1.04; 95% CI 1.01-1.09).
Conclusions:
- Preconception insurance is strongly associated with earlier initiation of prenatal care.
- Lack of preconception insurance is linked to delayed prenatal care and adverse perinatal outcomes.
- Ensuring preconception insurance coverage may improve timely access to essential maternal healthcare services.
Objective:
The primary objective was to determine the association between preconception insurance and initiation of prenatal care.
Study Design:
This retrospective cohort uses data from the Pregnancy Risk Assessment Monitoring System (2009-2013). Self-reported preconception insurance status was the primary exposure. The primary outcome was first trimester initiation of prenatal care. Secondary outcomes included: preterm delivery, birth weight, and the presence of birth defects. Survey-weighted generalized linear models were used to calculate risk ratios and accounted for state-level clustering.
Results:
Of the 181,675 included women from 32 states, 21.1% were uninsured prior to conception. 88% of insured women vs. 70% of uninsured women initiated care in the first trimester. Uninsured women were less likely to initiate care in the first trimester (adjusted relative risk (RR) 0.87 (95% confidence interval 0.85-0.89), p < 0.001) compared to women with insurance in the adjusted analysis. Among the secondary outcomes, uninsured nulliparous women had a 20% higher risk of extremely (<28 weeks) preterm delivery than those with preconception insurance (adjusted RR 1.20 (1.03-1.39), p = 0.01). Uninsured women also had a slightly increased risk of having SGA infant compared to insured women (adjusted RR 1.04 (1.01-1.09), p = 0.02). There were no differences in the other secondary outcomes.
Conclusions:
Preconception insurance is associated with earlier initiation of prenatal care.
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