Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Article
  • Published:

Comparison of birth outcomes of mothers covered by Medicaid versus those privately insured when accounting for social determinants of health

Journal of Perinatology volume 44, pages 488–492 (2024)Cite this article

Subjects

Abstract

Objectives

To determine the association between maternal health insurance type and birth outcomes [prematurity, small for gestational age (SGA), Term/Appropriate for gestational age NICU admission (Term/AGA-NICU) & composite birth outcomes (CBO)] accounting for social determinants of health.

Design/Methods

A cross-sectional study of maternal surveys and birth certificate data of singleton live births in NY born to mothers with Medicaid (M) or Private Insurance (PI).

Results

1015 mothers [M = 631, PI = 384) included. Individual birth outcomes did not differ between groups. Adjusting for social, demographic and clinical covariates, M mothers had similar odds of preterm birth, SGA, Term/AGA-NICU admission and CBO compared to PI.

Conclusions

M mothers were as likely as PI mothers to deliver a preterm, SGA or a Term/AGA-NICU infant after controlling for social determinants of health. Despite more social adversity among enrollees, our study suggests NY Medicaid recipients have similar birth outcomes to privately insured, socially advantaged women.

This is a preview of subscription content, access via your institution

Access options

Buy this article

  • Purchase on SpringerLink
  • Instant access to full article PDF
Buy now

Prices may be subject to local taxes which are calculated during checkout

Fig. 1: Flowchart of subjects approached, consented and included in the final analysis.

Similar content being viewed by others

References

  1. Jarvis C, Munoz M, Graves L, Stephenson R, D’Souza V, Jimenez V. Retrospective review of prenatal care and perinatal outcomes in a group of uninsured pregnant women. J Obstet Gynaecol Can. 2011;33:235–43.

    Article  PubMed  Google Scholar 

  2. Haas JS, Udvarhelyi S, Epstein AM. The effect of health coverage for uninsured pregnant women on maternal health and the use of Cesarean Section. JAMA. 1993;270:61–64.

    Article  CAS  PubMed  Google Scholar 

  3. Maupin R Jr, Lyman R, Fatsis J, Prystowiski E, Nguyen A, Wright C, et al. Characteristics of women who deliver with no prenatal care. J Matern Fetal Neonatal Med. 2004;16:45–50.

    Article  PubMed  Google Scholar 

  4. Valenzuela CP, Osterman MJK. Characteristics of mothers by source of payment for the delivery: United States, 2021. NCHS Data Brief, no 468. Hyattsville, MD: National Center for Health Statistics. 2023. Available at: https://www.cdc.gov/nchs/products/databriefs/db468.htm (Accessed 10 January 23).

  5. Markus AR, Krohe S, Garro N, Gerstein M, Pellegrini P. Examining the association between Medicaid coverage and preterm births using 2010–2013 National Vital Statistics Birth Data. J Child Poverty. 2017;23:79–94.

    Article  Google Scholar 

  6. Anum EA, Retchin SM, Garland SL, Strauss JF 3rd. Medicaid and preterm births in Virginia: an analysis of recent outcomes. J Women’s Health. 2010;19:1969–75.

    Article  Google Scholar 

  7. Anum EA, Retchin SM, Strauss JF 3rd. Medicaid and preterm birth and low birth weight: the last two decades. J Women’s Health. 2010;19:443–51.

    Article  Google Scholar 

  8. Taylor YJ, Liu TL, Howell EA. Insurance differences in preventive care use and adverse birth outcomes among pregnant women in a medicaid nonexpansion state: a retrospective cohort study. J Women’s Health. 2020;29:29–37.

    Article  Google Scholar 

  9. Buescher PA, Gizlice Z, Jones-Vessey KA. Discrepancies between published data on racial classification and self-reported race: evidence from the 2002 North Carolina live birth records. Public Health Rep. 2005;120:393–8.

    Article  PubMed  PubMed Central  Google Scholar 

  10. Kressin NR, Chang BH, Hendricks A, Kazis LE. Agreement between administrative data and patients’ self-reports of race/ethnicity. Am J Public Health. 2003;93:1734–9.

    Article  PubMed  PubMed Central  Google Scholar 

  11. Boehmer U, Kressin NR, Berlowitz DR, Christiansen CL, Kazis LE, Jones JA. Self-reported vs administrative race/ethnicity data and study results. Am J Public Health. 2002;92:1471–2.

    Article  PubMed  PubMed Central  Google Scholar 

  12. Wallace ME, Mendola P, Chen Z, Hwang BS, Grantz KL. Preterm birth in the context of increasing income inequality. Matern Child Health J. 2016;20:164–71.

    Article  PubMed  PubMed Central  Google Scholar 

  13. Borrell LN, Rodriguez-Alvarez E, Savitz DA, Baquero MC. Parental race/ethnicity and adverse birth outcomes in New York City: 2000-2010. Am J Public Health. 2016;106:1491–7.

    Article  PubMed  PubMed Central  Google Scholar 

  14. Swaminathan A, Lahaie Luna M, Rennicks White R, Smith G, Rodger M, Wen SW, et al. The influence of maternal and paternal education on birth outcomes: an analysis of the Ottawa and Kingston (OaK) birth cohort. J Matern Fetal Neonatal Med. 2022;35:9631–8.

    Article  PubMed  Google Scholar 

  15. Luo ZC, Wilkins R, Kramer MS. Fetal and Infant Health Study Group of the Canadian Perinatal Surveillance System. Effect of neighbourhood income and maternal education on birth outcomes: a population-based study. CMAJ. 2006;174:1415–20.

    Article  PubMed  PubMed Central  Google Scholar 

  16. DiTosto JD, Holder K, Soyemi E, Beestrum M, Yee LM. Housing instability and adverse perinatal outcomes: a systematic review. Am J Obstet Gynecol MFM. 2021;3:100477. https://doi.org/10.1016/j.ajogmf.2021.100477.

    Article  PubMed  PubMed Central  Google Scholar 

  17. Fang J, Madhavan S, Alderman MH. Low birth weight: race and maternal nativity-impact of community income. Pediatrics. 1999;103:E5.

    Article  CAS  PubMed  Google Scholar 

  18. McIntosh LJ, Roumayah NE, Bottoms SF. Perinatal outcome of broken marriage in the inner city. Obstet Gynecol. 1995;85:233–6.

    Article  CAS  PubMed  Google Scholar 

  19. King BC, Mowitz ME, Zupancic JAF. The financial burden on families of infants requiring neonatal intensive care. Semin Perinatol. 2021;45:151394.

    Article  PubMed  Google Scholar 

  20. Harrison W, Goodman D. Epidemiologic trends in neonatal intensive care, 2007-2012. JAMA Pediatr. 2015;169:855–62.

    Article  PubMed  Google Scholar 

  21. Talisman S, Guedalia J, Farkash R, Avitan T, Srebnik N, Kasirer Y, et al. NICU admission for term neonates in a large single-center population: a comprehensive assessment of risk factors using a tandem analysis approach. J Clin Med. 2022;11:4258.

    Article  PubMed  PubMed Central  Google Scholar 

  22. Wanasinghe D, Shah S, Bamanikar A, Aboudi G, Mikkilineni S, Shyong O, et al. Lifestyle characteristics of parental electronic cigarette and marijuana users: Healthy or not?. J Perinat Med. 2019;48:59–66.

    Article  PubMed  Google Scholar 

  23. Fenton TR, Kim JH. A systematic review and meta-analysis to revise the Fenton growth chart for preterm infants. BMC Pediatr. 2013;13:59. https://doi.org/10.1186/1471-2431-13-59.

    Article  PubMed  PubMed Central  Google Scholar 

  24. Meng Y, Groth SW. Fathers count: the impact of paternal risk factors on birth outcomes. Matern Child Health J. 2018;22:401–8.

    Article  PubMed  PubMed Central  Google Scholar 

  25. Galobardes B, Shaw M, Lawlor DA, Lynch JW, Davey Smith G. Indicators of socioeconomic position (part 1). J Epidemiol Community Health. 2006;60:7–12.

    Article  PubMed  PubMed Central  Google Scholar 

  26. Crume T, Juhl A, Brooks-Russell A, Hall K, Wymore E, Borgelt L. Cannabis use during the perinatal period in a state with legalized recreational and medical Marijuana: The Association between maternal characteristics, breastfeeding patterns, and neonatal outcomes. Obstet Gynecol Surv. 2018;73:609–11.

    Article  Google Scholar 

  27. Pregnancy Risk Assessment Monitoring System, Phase 7. Bethesda, MD: Center for Disease Control and Prevention, 2012. Available at: https://www.cdc.gov/prams/index.htm (Accessed 10 January 2020).

  28. Bamanikar AA, Shah S, Aboudi D, Mikkilineni S, Giblin C, Lavan T, et al. Impact of paternal presence and parental social-demographic characteristics on birth outcomes. J Perinat Med. 2021;49:1154–62.

    Article  PubMed  Google Scholar 

  29. Jawale N, Shah S, Wanasinghe D, Pool A, Damodaran K, Brumberg HL, et al. Intention to breastfeed and paternal influence on pregnant mothers exclusively using marijuana compared with other substances. Breastfeed Med. 2022;17:932–9.

    Article  PubMed  Google Scholar 

  30. United States Department of Health and Human Services. National Institutes of Health. National Institute on Drug Abuse, and United States Department of Health and Human Services. Food and Drug Administration. Center for Tobacco Products. Population Assessment of Tobacco and Health (PATH) Study [United States]. Ann Arbor, MI: Available at: https://www.icpsr.umich.edu/web/NAHDAP/studies/36231 (Accessed 10 January 2020).

  31. Jensen EA, Foglia EE, Dysart KC, Simmons RA, Aghai ZH, Cook A, et al. Adverse effects of small for gestational age differ by gestational week among very preterm infants. Arch Dis Child Fetal Neonatal Ed. 2019;104:F192–8.

    Article  PubMed  Google Scholar 

  32. Osterman MJK, Hamilton BE, Martin JA, Driscoll AK, Valenzuela CP. Births: Final data for 2021. National Vital Statistics Reports; Vol 72, No 1. Hyattsville, MD: National Center for Health Statistics. Available at: https://www.cdc.gov/nchs/data/nvsr/nvsr72/nvsr72-01.pdf (Accessed 10 January 2023).

  33. Bhargav SR, Thorsten V, Garces A, Pusdekar YV, Patel AB, Kurhe KG et al. Rates and risk factors for preterm birth and low birthweight in the global network sites in six low- and low-middle-income countries. Reprod Health. 2020;17:187.

    Article  PubMed  PubMed Central  Google Scholar 

  34. Battarbee AN, Sinkey RG, Harper LM, Oparil S, Tita ATN. Chronic hypertension in pregnancy. Am J Obstet Gynecol. 2020;222:532–41.

    Article  PubMed  Google Scholar 

  35. Sebastián Manzanares G, Angel Santalla H, Irene Vico Z, López Criado MS, Alicia Pineda L, José Luis Gallo V. Abnormal maternal body mass index and obstetric and neonatal outcome. J Matern Fetal Neonatal Med. 2012;25:308–12.

    Article  PubMed  Google Scholar 

  36. Henry J Kaiser Family Foundation. Kaiser Commission on Medicaid and the Uninsured. What is Medicaid’s Impact on Access to Care, health Outcomes, and Quality of Care? Issue Brief, August 2013. Avaiable at: https://www.kff.org/wp-content/uploads/2013/08/8467-what-is-medicaids-impact-on-access-to-care1.pdf (Accessed 10 November 2023).

  37. Ranji U, Gomez I, Salganicoff A. Medicaid Coverage of Pregnancy-Related Services: Findings from a 2021 State Survey. Kaiser Family Foundation, Women’s Health Policy; May 19th, 2022. Available at: https://www.kff.org/womens-health-policy/report/medicaid-coverage-of-pregnancy-related-services-findings-from-a-2021-state-survey/ (Accessed 10 November 2023).

  38. New York State Department of Health. New York State Medicaid. Available at: https://www.health.ny.gov/health_care/medicaid/ (Accessed 10 February 23).

  39. New York State Department of Health. New York State Medicaid. Medicaid Statistics. Available at: https://www.health.ny.gov/health_care/medicaid/statistics/ (Accessed 10 February 23).

  40. Morton SM, Bandara DK, Robinson EM, Carr PE. In the 21st Century, what is an acceptable response rate? Aust N. Z J Public Health. 2012;36:106–8.

    Article  PubMed  Google Scholar 

  41. New York State Department of Health: Live Birth Summary by Mother’s Race/Ethnicity, New York State, 2020. Available at: https://www.health.ny.gov/statistics/vital_statistics/2020/table04.htm (Accessed 10 December 2023).

Download references

Acknowledgements

We thank the medical students and research staff who helped us with the study methods.

Author information

Authors and Affiliations

  1. Division of Newborn Medicine, Maria Fareri Children’s Hospital at Westchester Medical Center, Valhalla, NY, USA

    Kriti Damodaran, Heather L. Brumberg, Clare Giblin & Shetal Shah

  2. Division of Neonatology, UHS, Binghamton General Hospital, Binghamton, NY, USA

    Nilima Jawale

Authors
  1. Kriti Damodaran
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Heather L. Brumberg
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Nilima Jawale
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Clare Giblin
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Shetal Shah
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

KD drafted the manuscript and performed the initial analysis. HLB assisted with analysis, reviewed drafts of manuscripts and made substantial contributions to draft. NJ performed preliminary analysis for the project.CG assisted with Institutional Review Board Applications at participating sites and contributed to data acquisition. SS conceived the original project, scientific design, analysis plan and reviewed multiple drafts of the paper. All the authors have accepted responsibility for the entire content of this submitted manuscript and approved submission.

Corresponding author

Correspondence to Shetal Shah.

Ethics declarations

Competing interests

The authors declare no competing interests.

Additional information

Publisher’s note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Damodaran, K., Brumberg, H.L., Jawale, N. et al. Comparison of birth outcomes of mothers covered by Medicaid versus those privately insured when accounting for social determinants of health. J Perinatol 44, 488–492 (2024). https://doi.org/10.1038/s41372-023-01842-x

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/s41372-023-01842-x

Search

Advanced search

Quick links