572 - The Association of Medicaid Expansion with Pregnancy-Related Outcomes for Adolescents

Poster Number: 572
Publication Number: 572.222

Katherine E. Douglas, Boston Children's Hospital, Boston Medical Center, Boston, MA, United States; Sunah Hwang, University of Colorado School of Medicine, Denver, CO, United States; Michael Monuteaux, Boston Children's Hospital, Boston, MA, United States; Lois K. Lee, Boston Children's Hospital, Harvard Medical School, Boston, MA, United States

Background: Pregnant adolescents are at increased risk for adverse pregnancy outcomes compared to the general birthing population. State Medicaid expansion through the Affordable Care Act has increased access to prenatal care for pregnant adults. Less is known about Medicaid expansion's effects on health outcomes for pregnant adolescents.

Objective:

For pregnant adolescents: (1) examine the association of state Medicaid expansion status with a) insurance attainment during pregnancy, b) inadequate prenatal care, c) gestational hypertension, and d) gestational diabetes; and (2) investigate if outcomes vary by maternal race/ethnicity.

Design/Methods:

This is a cross-sectional study of adolescents < 19 years old in the CDC’s 2019 Pregnancy Risk Assessment Monitoring System (PRAMS), a state population-based perinatal surveillance system of women who have a live birth. We compared adolescents’ pregnancy insurance acquisition by state Medicaid expansion status using the chi-square statistic. We conducted 3 multivariable logistic regression models with the outcomes of inadequate prenatal care, gestational hypertension, and gestational diabetes with Medicaid expansion and demographic factors as independent variables, reporting odds ratios (OR) and 95% confidence intervals (CI). The Adequacy of Prenatal Care Utilization (APNCU) score was dichotomized to adequate and inadequate care. The interaction of Medicaid expansion on stratified race/ethnicity outcomes was examined.

Results:

Among pregnant adolescents (weighted n=73910), those in Medicaid expansion states (weighted n=38133) were more likely to acquire insurance during pregnancy (p=0.006). In multivariable models, state Medicaid expansion status was not associated with inadequate prenatal care, gestational hypertension or gestational diabetes (Table). In these adjusted models there were significant racial and ethnic disparities with non-Hispanic Black adolescents having increased odds of inadequate prenatal care (OR 1.77, 95% CI 1.02, 3.05) and gestational hypertension (OR 2.18; 95% CI 1.23, 3.86). Hispanic adolescents had increased odds of gestational diabetes (OR 3.72, 95% CI 1.05, 13.13). There were no statistically significant interaction effects of Medicaid expansion and race/ethnicity for any outcomes.

Conclusion(s):

Medicaid expansion status is associated with increased prenatal insurance access for pregnant adolescents but not prenatal care adequacy. With significant racial and ethnic disparities, interventions beyond state Medicaid expansion may be needed to improve maternal outcomes for pregnant adolescents.