The Impact of Increased Medicaid Eligibility During Pregnancy on Medicaid Utilization and Gestational Age.

We compared three measures of maternal smoking status--prepregnancy, during pregnancy, and smoking cessation during pregnancy-between the Pregnancy Risk Assessment Monitoring System (PRAMS) questionnaire and the 2003 revised birth certificate (BC). We analyzed data from 10,485 women with live births in eight states from the 2008 PRAMS survey, a confidential, anonymous survey administered in the postpartum period that is linked to select BC variables. We calculated self-reported prepregnancy and prenatal smoking (last trimester only) prevalence based on the BC, the PRAMS survey, and the two data sources combined, and the percentage of smoking cessation during pregnancy based on the BC and PRAMS survey. We used two-sided t-tests to compare BC and PRAMS estimates. Prepregnancy smoking prevalence estimates were 17.3% from the BC, 24.4% from PRAMS, and 25.4% on one or both data sources. Prenatal smoking prevalence estimates were 11.3% from the BC, 14.0% from PRAMS, and 15.2% on one or both data sources. The percentages of prepregnancy smokers who indicated that they quit smoking by the last trimester were 35.1% from the BC and 42.6% from PRAMS. The PRAMS estimates of prepregnancy and prenatal smoking, and smoking cessation during pregnancy were statistically higher than the corresponding BC estimates (t-tests, p<0.05). PRAMS captured more women who smoked before and during the last trimester than the revised BC. States implementing PRAMS and the revised BC should consider information from both sources when developing population-based estimates of smoking before pregnancy and during the last trimester of pregnancy.

The article summarizes points from the report "Patterns of Health Insurance Coverage Around the Time of Pregnancy Among Women with Live-Born Infants-Pregnancy Risk Assessment Monitoring System, 29 States, 2009" published in 2015 in the "MMWR Surveillance Summaries" by the U.S. Centers for Disease Control and Prevention. It comments on the Pregnancy Risk Assessment Monitoring System which used weighted data from 29 states in calculating confidence intervals and prevalence estimates. It found around a third of women were transitioning between health insurance coverage types or lacked health insurance.

ACA and Medicaid Expansion Increased Breast Pump Claims and Breastfeeding for Women with Public and Private Insurance.

Disability and violence: Urgent call for data to achieve equity

Trends in Postpartum Contraceptive Use in 20 U.S. States and Jurisdictions: The Pregnancy Risk Assessment Monitoring System, 2015-2018.

State Medicaid programs have recently implemented several policies to improve access to health care during the postpartum period. Understanding whether these policies are succeeding will require accurate measurement of postpartum visit use over time and across states; however, current estimates of use vary substantially between data sources. To examine disagreement between postpartum visit use reported in the Pregnancy Risk Assessment Monitoring System (PRAMS) and Medicaid claims and assess whether insurance transitions from Medicaid at the time of childbirth to other insurance types after delivery are associated with the degree of disagreement. This cross-sectional study was conducted among individuals in South Carolina after delivery who had completed a PRAMS survey and for whom Medicaid was the payer of their delivery care. PRAMS responses from 2017 to 2020 were linked to inpatient, outpatient, and physician Medicaid claims; survey-weighted logistic regression models were then used to examine the association between postpartum insurance transitions and data source disagreement. Data were analyzed from February through October 2023. Insurance transition type: continuous Medicaid, Medicaid to private insurance, Medicaid to no insurance, and Emergency Medicaid to no insurance. Data source disagreement due to reporting a postpartum visit in PRAMS without a Medicaid claim for a visit or having a Medicaid claim for a visit without reporting a postpartum visit in PRAMS. Among 836 PRAMS respondents enrolled in Medicaid at delivery (663 aged 20-34 years [82.9%]), a mean of 85.7% (95% CI, 82.1%-88.7%) reported a postpartum visit in PRAMS and a mean of 61.6% (95% CI, 56.9%-66.0%) had a Medicaid claim for a postpartum visit. Overall, 253 respondents (30.3%; 95% CI, 26.1%-34.7%) had data source disagreement: 230 individuals (27.2%; 95% CI, 23.2%-31.5%) had a visit in PRAMS without a Medicaid claim, and 23 individuals (3.1%; 95% CI, 1.8%-5.2%) had a Medicaid claim without a visit in PRAMS. Compared with individuals continuously enrolled in Medicaid, those who transitioned to private insurance after delivery and those who were uninsured after delivery and had Emergency Medicaid at delivery had an increase in the probability of data source agreement of 15.8 percentage points (95% CI, 2.6-29.1 percentage points) and 37.2 percentage points (95% CI, 19.6-54.8 percentage points), respectively. This study's findings suggest that Medicaid claims may undercount postpartum visits among people who lose Medicaid or switch to private insurance after childbirth. Accounting for these insurance transitions may be associated with better claims-based estimates of postpartum care.

Opioid overdose and other related harms are a major source of morbidity and mortality among US Veterans, in part due to high-risk opioid prescribing. We sought to determine whether having multiple sources of payment for opioids-as a marker for out-of-system access-is associated with risky opioid therapy among veterans. Cross-sectional study examining the association between multiple sources of payment and risky opioid therapy among all individuals with Veterans Health Administration (VHA) payment for opioid analgesic prescriptions in Kentucky during fiscal year 2014-2015. Source of payment categories: (1) VHA only source of payment (sole source); (2) sources of payment were VHA and at least 1 cash payment [VHA+cash payment(s)] whether or not there was a third source of payment; and (3) at least one other noncash source: Medicare, Medicaid, or private insurance [VHA+noncash source(s)]. Our outcomes were 2 risky opioid therapies: combination opioid/benzodiazepine therapy and high-dose opioid therapy, defined as morphine equivalent daily dose ≥90 mg. Of the 14,795 individuals in the analytic sample, there were 81.9% in the sole source category, 6.6% in the VHA+cash payment(s) category, and 11.5% in the VHA+noncash source(s) category. In logistic regression, controlling for age and sex, persons with multiple payment sources had significantly higher odds of each risky opioid therapy, with those in the VHA+cash having significantly higher odds than those in the VHA+noncash source(s) group. Prescribers should examine the prescription monitoring program as multiple payment sources increase the odds of risky opioid therapy.

Identifying Risk Factors for Child Maltreatment in Alaska: A Population-Based Approach

To compare two data sources from Wisconsin-Medicaid claims and Pregnancy Risk Assessment Monitoring System (PRAMS) surveys-for measuring postpartum care utilization and to better understand the incongruence between the sources. We used linked Medicaid claims and PRAMS surveys of Wisconsin residents who delivered a live birth during 2011-2015 to assess women's postpartum care utilization. Three different definitions of postpartum care from Medicaid claims were employed to better examine bundled service codes and timing of care. We used one question from the PRAMS survey that asks women if they have had a postpartum checkup. Concordance between the two data sources was examined using Cohen's Kappa value. For women who reported having a postpartum checkup on PRAMS but did not have a Medicaid claim for a traditional postpartum visit, we determined the other types of health care visits these women had after delivery documented in the Medicaid claims. Among the 2313 women with a Medicaid-paid delivery and who completed a PRAMS survey, 86.6% had claims for a postpartum visit during the first 12weeks postpartum and 90.5% self-reported a postpartum checkup on PRAMS (percent agreement = 79.9%, Kappa = 0.015). The percent agreement and Kappa values varied based on the definition of postpartum care derived from the Medicaid claims data. There was slight agreement between Medicaid claims and PRAMS data. Most women had Medicaid claims for postpartum care at some point in the first 12weeks postpartum, although the timing of these visits was somewhat unclear due to the use of bundled service codes.

Introduction: Excessive gestational weight gain (GWG) is associated with adverse outcomes for women and infants (gestational hypertension, cesarean delivery, postpartum weight retention and large for gestational-age infants). Current population-based trends in GWG are unknown. This study estimates current trends in mean GWG and trends in gaining below, within, and above the 1990 IOM recommendations among women who delivered live births in multiple states from 2000-2009. Methods: We included Pregnancy Risk Assessment Monitoring System (PRAMS) data from 95,025 women ≥18 years of age, who delivered a singleton infant between 39-40 weeks gestational age in one of 14 states during 2000 through 2009. We defined self-reported GWG in pounds as a continuous variable and as a three-level categorical variable according to 1990 IOM recommendations (below, within and above recommendations). Self-reported pre-pregnancy weight and height from PRAMS were used to calculate pre-pregnancy body mass index and gestational weight gain was extracted from the birth certificate. We grouped live births into 5 biennial intervals and estimated percentage point changes in prevalence using the beta coefficient of the biennial intervals. Adjusted trends in gaining below or above (compared to within) IOM recommendations for GWG from 2000-2001 to 2008-2009 were assessed using multivariable multinomial linear regression. We examined the trend in mean GWG from 2000-2001 to 2008-2009 using multivariable linear regression adjusted for maternal and pregnancy characteristics. SUDAAN was used to account for the complex sampling design and weights were used to provide population-based estimates. Results: There was a 0.9 biennial percentage point increase in the percent of women gaining above IOM recommendations, from 43% in 2000-2001 to 46% in 2008-2009 (p- trend &lt; 0.01). Women gaining within IOM recommendations decreased at a rate of 1.1 percentage points biennially, from 38% in 2000-2001 to 34% in 2008-2009 (p-trend &lt;0.01). There was a statistically significant increase in the adjusted odds of gaining above (odds ratio (OR) = 1.2, 95% confidence interval (CI: 1.1-1.2) and below (OR= 1.2, 95% CI: 1.1-1.3) IOM recommendations over time. From 2000-2009, there was no change in mean GWG. Conclusion: From 2000-2009, there was a modest increase in the percent of women gaining above IOM recommendations while mean GWG remained constant. These seemingly contradictory findings may be due to a larger percentage of women entering pregnancy overweight and obese and gaining above recommended limits. Results from this analysis highlight the need for continued clinical and public health efforts to develop and implement effective strategies to ensure women enter pregnancy at a healthy weight and achieve recommended GWG.

Sudden unexpected infant death (SUID) is the leading cause of postneonatal mortality, with disparities attributed to social determinants of health (SDOH). SUID in the Hispanic population has received limited attention, despite the fact that one-fourth of US children are Hispanic. To compare SUID rates and risk factors among Hispanic and non-Hispanic infants, and associated interactions among SUID, SDOH, and acculturation. This US nationwide retrospective cohort study used US National Center for Health Statistics (NCHS) linked birth and infant death data, and Pregnancy Risk Assessment Monitoring System (PRAMS) data from 1996 to 2017. All live births (NCHS) or participants (PRAMS) with documented maternal ethnicity were included. Data were analyzed from February to October 2024. Maternal Hispanic ethnicity. The primary outcome was postneonatal SUID occurring at age 28 to 364 days, as designated by International Classification of Diseases, Ninth Revision codes 798, 799, and 913 (1996-1999), and International Statistical Classification of Diseases and Related Health Problems, Tenth Revision codes R95, R99, and W75 (2000-2017). Odds ratios (ORs) were calculated by exposure, and adjusted ORs controlled for risk factors in a multivariable model. Maternal nativity variables associated with race, poverty, local SUID rates, and region of origin were investigated. Subgroup analysis explored the relative association of Hispanic ethnicity with SUID risk factors. Maternally reported risk factors were compared according to Hispanic ethnicity. Among 88 067 608 live births (median [IQR] maternal age, 27 [22-32] years; median [IQR] gestational age, 39 [38-40] weeks) and 54 828 SUID deaths, there were 7173 SUID deaths among 19 887 156 Hispanic infants. The SUID rate was lower for Hispanic infants (0.36 deaths per 1000 live births) than for non-Hispanic infants (0.70 deaths per 1000 live births), across essentially all factors analyzed. Overall, Hispanic infants had 33% lower odds of SUID than non-Hispanic infants (adjusted OR, 0.67; 95% CI, 0.65-0.69). Infants of non-US-born Hispanic mothers had lower SUID rates, regardless of race, county-level poverty, local SUID rates, or Hispanic region of origin, except Puerto Rican infants. Altered associations with detrimental and protective factors were found, despite a mixed picture of risk. In this cohort study of SUID in infants born from 1996 to 2017, Hispanic infants had lower SUID rates than non-Hispanic infants, despite adverse SDOH. Risk factors operated differently in Hispanic infants, challenging current conceptualizations of risk. Understanding how risk operates in Hispanic populations can help to better address the mortality burden of SUID.

Hypertensive disorders of pregnancy have lifelong implications on maternal cardiovascular health. Breastfeeding has a variety of maternal benefits, including improved lifelong maternal cardiovascular outcomes, with longer periods of lactation resulting in further improvement. Women with hypertensive disorders of pregnancy encounter many barriers to breastfeeding. Little is known about lactation initiation and duration rates in women with hypertensive disorders of pregnancy. The purpose of this study is to describe lactation patterns in women with HDP, hypertensive disorders of pregnancy, compared to normotensive controls using data from the phase 7 Illinois Pregnancy Risk Assessment Monitoring System (PRAMS). Illinois PRAMS 2012-2015 (Phase 7) data was used to assess lactation patterns as well as rationale for not initiating breastfeeding or earlier cessation. Women who delivered during this time period were eligible to participate in the PRAMS survey, 5285 were included the analysis. Overall, 17.6% of all women in the study reported their healthcare provider did not speak with them prenatally about breastfeeding. Women who reported they had HDP, were significantly less likely (p ≤ 0.001) to ever breastfeed or pump breast milk to feed their baby, even for a short period, than those women without an HDP. At the time the PRAMS survey was completed, more women without an HDP were still breastfeeding or providing their baby with pumped milk (54.9 v. 48%; p = 0.002). More women with HDP reported stopping breastfeeding because they got sick or had to stop for medical reasons (p = 0.002) and/or because their baby was jaundiced (p = 0.007). Cardiovascular disease remains the leading cause of death among women and women with a history of HDP are at increased risk for cardiovascular related morbidity and mortality. Obstetrical providers and nurses caring for this high-risk population should ensure they educate women about the increased cardiovascular risk associated with HDP and the maternal cardiovascular benefits associated with lactation in order to promote and support lactation in this population of women.

To test the effects of state prescription contraception insurance mandates on unintended, mistimed, and unwanted births in a sample of privately insured recent mothers. We pooled Pregnancy Risk Assessment Monitoring System (PRAMS) data from 1997 to 2012 to study 209,964 privately insured recent mothers in 24 states, 11 of which implemented prescription contraception coverage mandates between 2000 and 2008. Individual-level difference-in-differences models compare the probability of unintended birth among privately insured recent mothers in state-years with mandates to those in state-years without mandates. Additional models use aggregate data to estimate the effect of mandates on states' number of unintended births. State mandates are associated with decreased probability of unintended birth (1.58 percentage points) among privately insured women in the second year of implementation, driven by decreased probability of mistimed birth (1.37 percentage points or 614 births per state-year) in the second year of implementation. We find no effects in the first year of implementation or on the probability of unwanted birth. Unexpectedly, recent mothers without private insurance experienced declines in unintended birth, but among unwanted, rather than mistimed, births. State prescription contraception insurance mandates are associated with reduced probability of unintended and mistimed births among privately insured women.

ObjectivesTo inform updates to the Pregnancy Risk Assessment Monitoring System (PRAMS) design and processes, African American/Black and Hispanic/Latina women in Florida provided feedback on their awareness and perceptions of the PRAMS survey, and preferences for survey distribution, completion, design and content.MethodsFocus groups were conducted in English and Spanish with 29 women in two large metropolitan counties. Participants completed a brief survey, reviewed the PRAMS questionnaire and recruitment materials, engaged in discussion, and gave feedback directly onto cover design posters.ResultsParticipants reported limited awareness of PRAMS. Preferences for survey distribution and completion varied by participant lifestyle. Interest in topics covered by PRAMS was as a motivator for completion, while distrust and confidentiality concerns were deterrents. Participants were least comfortable answering questions about income, illegal drug use, and pregnancy loss/infant death. Changes to the length of the survey, distribution methods, and incentives/rewards for completion were recommended.Conclusions for PracticeResults highlight the need to increase PRAMS awareness, build trust, and consider the design, length and modality for questionnaire completion as possible avenues to improve PRAMS response rates.

Women who conceive with the assistance of fertility treatments are at increased risk for multiple-gestation pregnancies and accompanying adverse pregnancy outcomes. The Pregnancy Risk Assessment Monitoring System (PRAMS) can be used to assess outcomes associated with fertility treatments, but a previous study suggested that PRAMS questions about fertility treatments overestimated use of assisted reproductive technology (ART) by 2.6 times. These PRAMS ART questions were revised in 2004. We compared prevalence estimates based on revised questions with counts from the National ART Surveillance System (NASS), the standard for describing ART prevalence. We compared weighted PRAMS prevalence estimates of births conceived by using ART with corresponding counts from NASS for three states (Florida, Maryland, and Utah) for 2004. We also compared these data by age, parity, plurality, and infant birthweight. Estimated ART births determined from PRAMS totaled 3,672 (95% confidence interval 2,210, 5,134), compared with 2,939 ART births reported to NASS. PRAMS estimates and NASS counts differed by maternal age (p=0.02) and parity (p<0.01). For example, PRAMS responses from women aged ≥ 40 years overestimated ART use by 70% (27.9% vs. 16.5%, p<0.01). Revised PRAMS questions better estimate numbers of ART births than earlier PRAMS questions. PRAMS data are useful to describe behaviors and outcomes associated with ART use.