Introduction: Preconception and interconception health care are critical means of identifying, managing, and treating risk factors originating prior to pregnancy that can harm fetal development and maternal health. However, many women in the U.S. lack health insurance, limiting their ability to access such care. State-level variation in Medicaid eligibility, particularly before and after the 2014 Medicaid expansions, offers a unique opportunity to test the hypothesis that increasing healthcare coverage for low-income women can improve preconception and interconception healthcare access and utilization, chronic disease management, overall health, and health behaviors. Methods:In 2018-2019, data on 58,365 low-income women aged 18-44 years from the 2011-2016 Behavioral Risk Factor Surveillance System were analyzed and a difference-in-difference analysis was used to examine the impact of Medicaid expansions on preconception health.Results: Expanded Medicaid eligibility was associated with increased healthcare coverage and utilization, better self-rated health, and decreases in avoidance of care because of cost, heavy drinking, and binge drinking. Medicaid eligibility did not impact diagnoses of chronic conditions, smoking cessation, or BMI. Medicaid eligibility was associated with greater gains in health insurance, utilization, and health among married (versus unmarried) women. Conversely, women with any (versus no) dependent children experienced smaller gains in insurance following the Medicaid expansion, but greater take-up of insurance when eligibility increased and larger behavioral responses to gaining insurance.Conclusions: Expanded Medicaid coverage may improve access to and utilization of health care among women of reproductive age, which could ultimately improve preconception health.

Count per 100,000 live births in that racial and ethnic group from 2010 to 2019. † Rate ratio5pregnancy-associated death ratio in group divided by pregnancy-associated death ratio in reference group.

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(Am J Obstet Gynecol. 2019;221:489.e1–489.e9) Efforts to reduce maternal mortality has become a priority worldwide and in the United States. In 2018, the Preventing Maternal Deaths Act was enacted to support state efforts to track and review maternal deaths. Also, targeted action plans and safety bundles for clinical care that focus on common causes of maternal mortality have been developed. Yet, there is limited evidence on the impact that drug-related deaths and suicide have on postpartum women. The aim of this study was to determine the incidence of drug-related deaths and suicide among women in California up to a year after giving birth and to examine their utilization of health care services between delivery and postpartum death.

Preconception healthcare is heralded as an essential method of improving pregnancy health and outcomes. However, access to healthcare for low-income women of reproductive age has been limited because of a lack of health insurance. Expansions of Medicaid eligibility under the Affordable Care Act (as well as prior expansions in some states) have changed this circumstance and expanded health insurance coverage for low income women. These Medicaid expansions provide an opportunity to assess whether obtaining health insurance coverage improves pre-pregnancy and pregnancy health and reduces prevalence of adverse pregnancy outcomes. We tested this hypothesis using vital statistics data from 2011-2017 on singleton births to United States resident women ages 15 to 44. We examined associations between preconception exposure to Medicaid expansion and measures of pre-pregnancy health, pregnancy health, and pregnancy outcomes using a difference-in-differences empirical approach. Increased Medicaid eligibility was not associated with improvements in pre-pregnancy or pregnancy health measures and did not reduce prevalence of adverse birth outcomes (e.g., preterm birth increased by 0.1 percentage points [95% CI: -0.2, 0.3]). Increasing Medicaid eligibility alone may be insufficient to improve pre-pregnancy or pregnancy health and birth outcomes. Preconception programming in combination with attention to other structural determinants of pregnancy health is needed.