Association Between Insurance and Adequacy of Prenatal Care [257

Abstract

INTRODUCTION: Obese women and Medicaid recipients have an increased risk of poor pregnancy outcomes, which has been thought to be the result of inadequate prenatal care. However, our prior work demonstrated that maternal obesity is associated with an improved adequacy of prenatal care in our population. Although obesity was associated with increased use of ultrasound services, this alone did not explain the improvement in prenatal care adequacy associated with obesity. We sought to further examine whether payer status influences prenatal care adequacy. METHODS: From a University of Rochester database of deliveries from January 2009 to December 2011, participants were categorized by body mass index (BMI, calculated as weight (kg)/[height (m)]2) as normal weight (BMI 18.5–24.9), overweight (BMI 25–29.9), and obese (BMI 30, subdivided as class I, II, III). Prenatal care adequacy was evaluated using the Kotelchuck Index. Payer status was defined as private, Medicaid, and other (tricare, self-pay). χ2 was used for univariate comparisons and logistic regression for multivariable testing. RESULTS: Of 7,090 deliveries, inadequate prenatal care was more common in both Medicaid (32.7%; odds ratio [OR] 1.24, 95% confidence interval [CI] 1.11–1.38) and other insurance groups (43.4%; OR 1.95, 95% CI 1.13–3.37) compared with private insurance (28.2% inadequate). After adjusting for age, race, education, obesity class, diabetes, and hypertension, payer status remained a significant predictor of inadequate prenatal care (Medicaid OR 1.18, 95% CI 1.03–1.35; “other” OR 1.85, 95% CI 1.05–3.24). CONCLUSION: Medicaid and other nonprivate insurance payer statuses are associated with higher rates of inadequate prenatal care compared with private insurance regardless of obesity status and potential confounders. The reason for less adequate care in these groups is unclear.