640: Impact of insurance status on outcomes in women with hypertensive disorders in pregnancy

Abstract

Hypertension in pregnancy is associated with adverse maternal and neonatal outcomes. Yet, data on the association of insurance status, classification of hypertension in pregnancy and outcomes have not been well described. We sought to compare outcomes in women with hypertensive disorders of pregnancy by private versus public insurance. This is a retrospective cohort study of subjects with a hypertensive disorder of pregnancy that delivered ≥23 weeks gestation at a single institution in Oregon (October ‘13 - May ’17). The cohort began with the 2013 American College of Obstetricians and Gynecologists Executive Summary on Hypertension in Pregnancy, which advised surveillance for severe features of disease in women with hypertension. Utilizing ICD-9 and ICD-10 discharge codes, followed by individual chart review, we abstracted data on severe features into four groups: i) chronic hypertension; ii) gestational hypertension; iii) preeclampsia (PE) without severe features and, iv) PE with severe features. We then stratified subjects into two groups by insurance status: i) Medicaid (public insurance) or ii) individual or group health insurance (private insurance). Demographic and outcome data were abstracted, with analysis by chi-square, t-test, and logistic regression. Among 8,645 deliveries, 1,188 (13.7%) were delivered with a hypertensive disorder of pregnancy. Medicaid covered 54.97% (653) of these deliveries; 43.18% (513) were covered by private insurance, and 1.85% (22) were unknown. There were a similar percentage of Medicaid patients in each hypertensive group (p=0.17). Compared to subjects with private insurance, those with Medicaid had more severe features of preeclampsia, primarily severe systolic BP ≥160 mmHg. Neonates of subjects with Medicaid had more preterm births, intensive care unit admissions and respiratory distress syndrome (Table 1). The association between Medicaid, severe features of preeclampsia and adverse neonatal outcomes persisted after multivariable adjustment (Table 2). Medicaid insurance did not associate with a particular hypertensive disorder, yet those with Medicaid experienced more severe features of preeclampsia and higher rates of adverse neonatal outcomes. More research is needed to understand potential risk factors and ways to improve outcomes for those with publicly funded insurance.View Large Image Figure ViewerDownload Hi-res image Download (PPT)