Pre-pregnancy insurance coverage gaps and timing of prenatal care initiation

Health insurance coverage is important for accessing prenatal care, yet the association of pre-conception gaps in health insurance coverage with prenatal care initiation is unknown. Experiencing uninsurance before pregnancy could discourage use of preventive care, including prenatal care, due to difficulties with finding a provider, negative experiences with seeking care while uninsured, or medical debt accumulation. We used 2013-2023 data from a longitudinal US panel study to analyze how pre-pregnancy gaps in coverage (part-year uninsurance) and year-round lack of coverage were associated with prenatal care timing and number of visits. Among 556 respondents, 8 percent experienced part-year uninsurance and another 11 percent experienced year-round uninsurance before pregnancy. On multivariable analysis, lack of insurance before pregnancy was not associated with the first prenatal care visit timing, but part-year uninsurance pre-conception was associated with 1.6 more prenatal care visits (95 percent confidence interval: 0.3, 2.9), relative to year-round private insurance before conception. All but one of the respondents with gaps in coverage before pregnancy had obtained some type of insurance by the time of delivery. Gaining health insurance coverage during pregnancy appears to disrupt the association between a history of uninsurance and preventive care use, specifically in the context of initiating and continuing prenatal care.