Preconception insurance and initiation of prenatal care.

Abstract

The primary objective was to determine the association between preconception insurance and initiation of prenatal care. 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. 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. Preconception insurance is associated with earlier initiation of prenatal care.