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Preconception insurance and initiation of prenatal care

Journal of Perinatology volume 39, pages 300–306 (2019)Cite this article

Subjects

Abstract

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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Acknowledgements

The data were provided by the Centers for Disease Control and Prevention and the Pregnancy Risk Assessment Monitoring System (PRAMS) working group. A full list of working group members can be found online at https://www.cdc.gov/prams/researchers.htm.

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Authors and Affiliations

  1. Department of Obstetrics and Gynecology, Massachusetts General Hospital, Boston, MA, USA

    Mark A. Clapp & Anjali J. Kaimal

  2. Harvard Medical School, Boston, MA, USA

    Mark A. Clapp & Anjali J. Kaimal

  3. Department of Obstetrics and Gynecology, Deborah Kelly Center for Outcomes Research, Massachusetts General Hospital, Boston, MA, USA

    Kaitlyn E. James

Authors
  1. Mark A. Clapp
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Corresponding author

Correspondence to Mark A. Clapp.

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The authors declare that they have no conflict of interest.

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Clapp, M.A., James, K.E. & Kaimal, A.J. Preconception insurance and initiation of prenatal care. J Perinatol 39, 300–306 (2019). https://doi.org/10.1038/s41372-018-0292-7

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