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The association between maternal insurance status on maternal and neonatal outcomes in women with hypertensive disorders of pregnancy

Journal of Human Hypertension volume 38, pages 75–80 (2024)Cite this article

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Abstract

The objective of this study was to examine the association between maternal insurance status and maternal and neonatal adverse outcomes in women who had hypertensive disorders in pregnancy. A population-based retrospective cohort study was undertaken using the US Vital Statistics dataset on Period Linked Birth-Infant Data from 2016–2020. The study population was restricted to non-anomalous births from women whose pregnancies were complicated by hypertensive disorders. Insurance status was categorized as private, Medicaid, self-pay and other. The primary outcome was a composite of maternal adverse outcomes, which included admission to the intensive care unit, unplanned hysterectomy, maternal blood transfusion or uterine rupture. We examined the role of prenatal care in these relationships using a mediation analysis with Kotelchuck’s Adequacy of Prenatal Care Utilization Index. Multivariable logistic regression models were used to estimate the association between maternal insurance status and adverse outcomes (using adjusted odds ratios [aOR] and 99% confidence interval [CI]). Of the 18,999,865 live births in the five-year study, 1,642,654 (8.6%) met the inclusion criteria. The frequency of the composite maternal adverse outcome was 1.3%. The maternal composite occurred more frequently in women with Medicaid (aOR = 1.11, 99% CI: 1.06, 1.16) or self-pay (aOR = 1.40, 99% CI: 1.25, 1.55) when compared to private insurance. Adjusting for prenatal care slightly attenuated this association, but remained significant. Among women with hypertensive disorders in pregnancy, women with Medicaid insurance or self-pay were more likely to experience maternal and neonatal adverse outcomes than women with private insurance.

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Fig. 1: Flow chart of live births in the US (2016–2020): eligibility and sample size.

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Data availability

The data for this project is publicly available.

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Authors and Affiliations

  1. Department of Epidemiology, Tulane School of Public Health and Tropical Medicine, New Orleans, LA, USA

    Farah Allouch

  2. Pomona Valley Hospital Medical Center, West Covina, CA, USA

    Richard Burwick

  3. Department of Obstetrics and Gynecology, Alpert Medical School, Brown University, Providence, RI, USA

    Megha Gupta & Stephen Wagner

  4. Department of Obstetrics, Gynecology, and Reproductive Sciences, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, TX, USA

    Michal Fishel Bartal, Matthew J. Bicocca & Suneet P. Chauhan

Authors
  1. Farah Allouch
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  2. Richard Burwick
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  3. Megha Gupta
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  4. Michal Fishel Bartal
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  5. Matthew J. Bicocca
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  6. Suneet P. Chauhan
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  7. Stephen Wagner
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Contributions

FA: Conceptualization, Methodology, Formal Analysis, Data Curation. RB: Visualization, Supervision, Writing – Review and Editing. MG: Conceptualization, Writing- Review and Editing. MFB: Conceptualization, Writing- Review and Editing. MJB: Conceptualization. SPC: Supervision. SW: Conceptualization, Project administration, Writing- Original Draft.

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Correspondence to Stephen Wagner.

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Allouch, F., Burwick, R., Gupta, M. et al. The association between maternal insurance status on maternal and neonatal outcomes in women with hypertensive disorders of pregnancy. J Hum Hypertens 38, 75–80 (2024). https://doi.org/10.1038/s41371-023-00809-x

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