(332) Disparities in Prenatal Care Initiation Among Medicaid and Commercially Insured Pregnant Women

Objective:
Access to prenatal care is critical to improving pregnancy outcomes, yet disparities in its timing and quality persist. Our objective is to elucidate how insurance type is associated with the timing of prenatal care initiation and maternal and neonatal outcomes.

Study Design: A retrospective cohort study was conducted using CDC National Vital Statistics System data from 2018 to 2022. Pregnant women were categorized based on their insurance status: Medicaid or commercially insured. We analyzed variables related to maternal demographics, health behaviors, and birth outcomes. The primary outcome was prenatal care within the 1st trimester. Adjusted odds ratios (aORs) and 95% confidence intervals (CIs) were calculated using logistic regression to account for potential confounders. Chi-squared test for independence to compare the proportions of prenatal care initiation times. Statistical significance was determined with a p-value threshold of < 0.001.


Results:


Of 16,828,197 total patients, 9,235,696 were commercially insured and 7,592,501 were on Medicaid. Prenatal care initiation showed significant differences, with 68.05% of Medicaid recipients starting care in the 1st trimester, compared to 86.23% of those commercially insured. A larger proportion of Medicaid recipients initiated care in the 2nd trimester (21.99% vs. 10.11%), the 3rd trimester (6.26% vs. 2.22%), or had no prenatal care at all (2.77% vs. 0.75%) (p< 0.001).

Women on Medicaid are over twice as likely [aOR: 2.118 (95% CI: 2.107-2.130, p< 0.001)] to receive prenatal care after the 1st trimester compared to commercial insurance after controlling for maternal age, marital status, ethnicity, and education level. Significant differences (p< 0.001) were also observed in: number of prenatal visits, smoking status before pregnancy, NICU admission, maternal ICU admission, postpartum hemorrhage, and preterm labor.



Conclusion: Disparities in the timing of prenatal care initiation between Medicaid and commercially insured pregnant women exist. Innovative engagement strategies may mitigate these disparities, ensuring timely and equitable prenatal care.