348 - Does maternal health insurance status impact preconception care screening for chronic diseases?

Monday, May 1, 2023

9:30 AM – 11:30 AM ET

Poster Number: 348
Publication Number: 348.448

KRITI DAMODARAN, Maria Fareri Children's Hospital at Westchester Medical Center, White Plains, NY, United States; Heather L. Brumberg, Westchester Medical Center, White Plains, NY, United States; Clare Giblin, Maria Fareri Children's Hospital at Westchester Me, Valhalla, NY, United States; Sarah M. Sanchez, Maria Fareri Children's Hospital at Westchester Medical Center, Valhalla, NY, United States; Elissa Dunlap, Maria Fareri Children's Hospital at Westchester Medical Center, New York, NY, United States; Shetal Shah, American Academy of Pediatrics, Syosset, NY, United States

Presenting Author(s)

Kriti Damodaran, MBBS, FAAP (she/her/hers)

Neonatal Fellow
Maria Fareri Children's Hospital at Westchester Medical Center
Maria Fareri Children's Hospital at Westchester Medical Center
White Plains, New York, United States

Background: The Centers for Medicare & Medicaid Services (CMS) is currently mandating all states review their Medicaid programs to determine opportunities for improvement of preconception and peripartum healthcare access. Preconception care screening (PCCS) for chronic diseases such as diabetes (DM) or hypertension (HTN) aims to promote baseline health and improve pregnancy related outcomes, however only 30% of women report receipt of any PCCS nationally. Specific rates of PCCS screening for chronic diseases among women enrolled in Medicaid in comparison to those privately insured are unknown but are important to assess in conjunction with the new CMS mandate.

Objective: To determine if maternal Medicaid vs Private insurance status is associated with differences in PCCS for DM, HTN or family medical history (FMH) while controlling for social determinants of health.

Design/Methods: This was a cross-sectional (2016-2021), self-reported survey-based study of mothers (≥18 years) of singleton live born infants at 6 birthing hospitals. Mothers were divided into 2 groups: Medicaid (M) & Private insurance (PI). Maternal characteristics included demographics and lifestyle behaviors. Logistic regression assessed odds of PCCS by maternal insurance type adjusting for self-reported race, age, education, marital status, foreign born, exercise, adverse life events, substance use, obesity, pre-existing DM and HTN.

Results: A total of 1015 mothers were analyzed (M=631, PI=384). M vs PI mothers were similarly screened for DM (25% vs 22%), HTN (27% vs 29%) and FMH (31% vs 35%) respectively (Table1). A greater percentage of non-white mothers were insured by M compared to PI. Mothers with PI had higher education, regular exercise, and higher rates of marriage. Receipt of PCCS for DM, HTN and FMH differed across racial/ethnic groups (Table 2). Rates of PCCS for DM and HTN were higher in mothers with these pre-existing conditions, respectively. In adjusted analysis, mothers insured by M compared with PI, had similar odds of PCCS for DM (OR 1.15, CI 0.75-1.74), HTN (OR 1.20, CI 0.79-1.77) and FMH (OR 1.12, CI 0.76-1.63).

Conclusion(s): Medicaid mothers are as likely as privately insured mothers to be screened for chronic diseases during preconception care in our region at suboptimal rates. Regardless of what insurance type providers accept, greater awareness of the importance of PCCS for chronic diseases may need to be highlighted. This may also serve as a novel opportunity for NYS Medicaid to further increase PCCS above PI due to a higher risk population.