Journal of perinatology : official journal of the California Perinatal Association · 2018
Preconception insurance and initiation of prenatal care.
СтатьяПоддержка службы здравоохранения СШАНазвание и аннотация: Перевод в очереди
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Clapp Mark A, James Kaitlyn E, Kaimal Anjali J
Аннотация
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.
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.