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Nov. 22, 2019

Study highlights impact of Medicaid expansion on pregnant women

Expanded Medicaid eligibility under the Affordable Care Act prompted more low-income women of reproductive age to sign up for health insurance, seek medical care and report improvements in their health, a study led by a College of Human Medicine researcher found.

Those findings are important, because they could lead to better health not only for the women but for any future children they bear, said Claire Margerison, the study’s lead author and an associate professor of epidemiology and biostatistics.

Prenatal care, which begins after a woman becomes pregnant, “often comes too late,” Margerison said. It might not fully address risks such as smoking, alcohol use, obesity and chronic diseases that adversely affect the development of the fetus as early as the first few weeks of gestation. 

Giving more women access to medical care before they become pregnant could improve their health and that of their babies, the study published in the American Journal of Preventive Medicine concluded.

“These results suggest they might enter pregnancy in better health,” Margerison said. “That would improve the outcome of their pregnancy as well.”

Adverse pregnancy outcomes – including low birthweight, premature delivery and maternal and infant mortality – are higher in the United States than in most other industrialized countries. 

The study, funded by a National Institutes of Health grant, was to evaluate the impact of government policies, including the expansion of Medicaid, on preconception health, pregnancy health, healthy behaviors and birth outcomes.  

It gathered data from 58,365 low-income women between the ages 18 and 44. Thirty-three states expanded Medicaid coverage to more low-income residents under the Affordable Care Act beginning in 2014.

Margerison’s study found that Medicaid expansion was associated with “increased healthcare coverage and utilization, better self-rated health, and decreases in avoidance of care due to cost, heavy drinking and binge drinking among low-income women of reproductive age.” 

However, the study did not find any change in the diagnoses for chronic conditions, such as diabetes, smoking addiction and high body mass index. Those outcomes could require a longer time to improve following expanded Medicaid, Margerison said. 

“Those are very difficult things to change, regardless of health care coverage,” she said. “We may see a larger impact later. We hope that over time we’ll see that getting health insurance will improve health for women of reproductive age.”

That, in turn, she said, will lead to better birth outcomes.

By: Geri Kelley

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