Underinsured Women May Be Missing Important Pregnancy Care

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

And for this group of patients, these insurance churns may make it less likely that they receive prenatal care in their first trimester or postpartum visits compared to those with steady insurance, a new Michigan Medicine-led study in JAMA Network Open suggests.

"Our findings show that disruptions in insurance are associated with lower levels of recommended pregnancy-related care," says lead author Lindsay Admon, M.D., M.Sc., an obstetrician-gynecologist and researcher at Michigan Medicine Von Voigtlander Women's Hospital.

"This suggests that insurance instability may contribute to the alarming disparities we've seen in maternal and child health outcomes."

Hispanic, Spanish-speaking women composed nearly two thirds of the women with continuous un-insurance, suggesting particularly high barriers to enrollment among this population potentially associated with immigration status, Admon says.

Researchers analyzed data between 2015-2017 that included a nationally-representative sample of 39,378 women with an average age of 27. Among them, about 44% were continuously insured. 21% experienced shifts between private coverage and Medicaid and 32% saw shifts between insurance and un-insurance. A little more than 2% were continuously without insurance.

Maternal Care Critical to Outcomes

Pregnant patients who don't receive prenatal care have a higher risk of adverse outcomes for babies, including low birth weights or death, Admon says. Regular maternal care also gives providers an opportunity to identify underlying health issues that may negatively affect a mother or baby's health. This includes preexisting conditions, such as heart disease and high blood pressure, which are among the leading causes of maternal morbidity and mortality.

Postpartum care is also critical for identifying serious and even life-threatening health complications that may occur days or weeks after giving birth. This may include cardiovascular diseases, an infection or high blood pressure among other health issues.

The new research follows a previous study by Admon and colleagues showing fewer insurance disruptions among low income pregnant patients in states with Medicaid expansion through the Affordable Care Act. The policy improved perinatal insurance continuity for low income women, authors concluded.

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

"Prenatal and postpartum is care is critical to keeping moms and babies healthy," Admon says. "We need to do more work to ensure all women –  regardless of race, ethnicity or income – have adequate maternal care coverage during every stage of pregnancy starting before conception and continuing after childbirth."

Paper cited: "Insurance Coverage and Perinatal Health Care Use Among Low-Income Women in the U.S., 2015-2017," JAMA Network Open. DOI: 10.1001/jamanetworkopen.2020.34549