Retrospective Review of Prenatal Care and Perinatal Outcomes in a Group of Uninsured Pregnant Women

Jarvis, Catherine; Muňoz, Marie; Graves, Lisa; Stephenson, Randolph; D’Souza, Vinita; Jimenez, Vania

doi:10.1016/s1701-2163(16)34824-1

Cited by 39 publications

(84 citation statements)

References 12 publications

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“…As anticipated, the number of prenatal visits reported for the uninsured group (mean = 6.04, t = −6.173, α = 0) was significantly lower, than for their insured peers (mean = 8.70). According to the Society of Obstetricians and Gynaecologists of Canada (SOGC), using these guidelines, adequate prenatal care is comprised of 9 to 12 visits starting during the fourth month of pregnancy or earlier [2,16,26]. Inadequate prenatal care can therefore be operationalized as fewer than nine visits that began after 21 weeks gestation.…”

Section: Resultsmentioning

confidence: 99%

“…Various healthcare organizations have stressed the importance of adequate prenatal care as an important predictor of optimal perinatal outcomes [1,2,3,4,5]. However, many immigrant and migrant women in Canada and the United States receive less than the recommended level of care due to their lack of public health care coverage [1].…”

Section: Introductionmentioning

confidence: 99%

“…Several Canadian reports describe the uninsured as having poorer perinatal outcomes in general [2,11,12], however, the impact of barriers such as lack of health insurance on health outcomes for women and their newborns still requires quantitative exploration. To date, few studies have examined the perinatal outcomes of uninsured mothers and their newborns within the Canadian context and compared them with the outcomes of their insured counterparts.…”

Section: Introductionmentioning

confidence: 99%

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Perinatal Outcomes of Uninsured Immigrant, Refugee and Migrant Mothers and Newborns Living in Toronto, Canada

Wilson‐Mitchell

Rummens

2013

IJERPH

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Canadian healthcare insurance is not universal for all newcomer populations. New immigrant, refugee claimant, and migrant women face various barriers to healthcare due to the lack of public health insurance coverage. This retrospective study explored the relationships between insurance status and various perinatal outcomes. Researchers examined and compared perinatal outcomes for 453 uninsured and provincially insured women who delivered at two general hospitals in the Greater Toronto Area between 2007 and 2010. Data on key perinatal health indicators were collected via chart review of hospital medical records. Comparisons were made with regional statistics and professional guidelines where available. Four-in-five uninsured pregnant women received less-than-adequate prenatal care. More than half of them received clearly inadequate prenatal care, and 6.5% received no prenatal care at all. Insurance status was also related to the type of health care provider, reason for caesarean section, neonatal resuscitation rates, and maternal length of hospital stay. Uninsured mothers experienced a higher percentage of caesarian sections due to abnormal fetal heart rates and required more neonatal resuscitations. No significant difference was found for low birth weight, preterm birth, NCIU admissions, postpartum hemorrhage, breast feeding, or intrapartum care provided.

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Section: Resultsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Perinatal Outcomes of Uninsured Immigrant, Refugee and Migrant Mothers and Newborns Living in Toronto, Canada

Wilson‐Mitchell

Rummens

2013

IJERPH

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“…Such preventive counseling has been associated with reduced odds of alcohol use during pregnancy (Elsinga et al, 2008). This would lead to lower risk for drinking among pregnant women with health insurance, as women with insurance are more likely to have health counseling to prepare for healthy pregnancy, have more prenatal visits, and present for prenatal care earlier than uninsured women (D'Angelo et al, 2007; Egerter et al, 2002; Jarvis et al, 2011), which increases their exposure to health messages and screening (Jarvis et al, 2011). This helps explain the lower odds of alcohol use among pregnant women in this study who were insured versus uninsured.…”

Section: Discussionmentioning

confidence: 99%

“…Insurance coverage and health care access among women of reproductive age could improve maternal and child health (D'Angelo et al, 2015) by improving access to timely and adequate prenatal care (D'Angelo et al, 2007; Egerter et al, 2002; Jarvis et al, 2011). For example, an estimated 30% of women receive preconception provider-delivered health counseling on preparing for a healthy pregnancy and baby, and approximately 90% of women receive health check-ups postpartum and between pregnancies (D’Angelo et al, 2007).…”

Section: Introductionmentioning

confidence: 99%

Health insurance, alcohol and tobacco use among pregnant and non-pregnant women of reproductive age

Brown

Hasin

Keyes

et al. 2016

Drug and Alcohol Dependence

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Background Understanding the relationship between health insurance coverage and tobacco and alcohol use among reproductive age women can provide important insight into the role of access to care in preventing tobacco and alcohol use among pregnant women and women planning to become pregnant. Methods We examined the association between health insurance coverage and both past month alcohol use and past month tobacco use in a nationally representative sample of women age 12-44 years old, by pregnancy status. The women (n=97,788) were participants in the National Survey of Drug Use and Health (NSDUH) in 2010-2013. Logistic regression models assessed the association between health insurance (insured versus uninsured), past month tobacco and alcohol use, and whether this was modified by pregnancy status. Results Pregnancy status significantly moderated the relationship between health insurance and tobacco use (p-value <0.01) and alcohol use (p-value <0.01). Among pregnant women, being insured was associated with lower odds of alcohol use (adjusted odds ratio [AOR]=0.47; 95% confidence interval [CI]=0.27-0.82), but not associated with tobacco use (AOR=1.14; 95% CI=0.73-1.76). Among non-pregnant women, being insured was associated with lower odds of tobacco use (AOR=0.67; 95% CI=0.63-0.72), but higher odds of alcohol use (AOR=1.23; 95% CI=1.15-1.32). Conclusion Access to health care, via health insurance coverage is a promising method to help reduce alcohol use during pregnancy. However, despite health insurance coverage, tobacco use persists during pregnancy, suggesting missed opportunities for prevention during prenatal visits.

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Financial Hardship Among Pregnant and Postpartum Women in the United States, 2013 to 2018

et al. 2021

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IMPORTANCEFinancial hardship affects health care access and health outcomes among peripartum women. OBJECTIVE To evaluate the prevalence of financial hardship among peripartum women over time and by insurance type and income. DESIGN, SETTING, AND PARTICIPANTS This cross-sectional study included peripartum women, defined as women aged 18 to 45 years who reported being currently pregnant or pregnant in the past 12 months, who participated in the National Health Interview Survey from 2013 to 2018. Data were analyzed from January to May 2021. EXPOSURES Current pregnancy or recent pregnancy as well as insurance type and income. MAIN OUTCOMES AND MEASURES Three measures of financial hardship within the last year were evaluated: (1) unmet health care need due to cost (unmet need for medical care or delayed or deferred medical care due to cost); (2) health care unaffordability (worry about paying for potential medical bills or existing medical debt); and (3) general financial stress (worry about subsistence spending [eg, monthly bills, housing]).

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Retrospective Review of Prenatal Care and Perinatal Outcomes in a Group of Uninsured Pregnant Women

Cited by 39 publications

References 12 publications

Perinatal Outcomes of Uninsured Immigrant, Refugee and Migrant Mothers and Newborns Living in Toronto, Canada

Perinatal Outcomes of Uninsured Immigrant, Refugee and Migrant Mothers and Newborns Living in Toronto, Canada

Health insurance, alcohol and tobacco use among pregnant and non-pregnant women of reproductive age

Financial Hardship Among Pregnant and Postpartum Women in the United States, 2013 to 2018

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