Black race (aOR 1.24; 95% CI 1.16-1.33), pregnancy-only Medicaid coverage, and second-trimester prenatal care entry were associated with increased odds of hypertensive disorders of pregnancy.
Observational
What maternal sociodemographic, clinical, and care utilization characteristics are associated with hypertensive disorders of pregnancy among Medicaid recipients in a nonexpansion state?
Beyond traditional risk factors, lack of preconception insurance and delayed prenatal care entry are associated with higher odds of hypertensive disorders of pregnancy among Medicaid recipients.
Effect estimate: aOR 1.24 (95% CI 1.16-1.33)
Background: The incidence of hypertensive disorders of pregnancy (HDP) are on the rise in the United States, especially in the South, which has a heavy chronic disease burden and large number of Medicaid nonexpansion states. Sizeable disparities in HDP outcomes exist by race/ethnicity, geography, and health insurance coverage. Our objective is to explore HDP in the Alabama Medicaid maternity population, and the association of maternal sociodemographic, clinical, and care utilization characteristics with HDP diagnosis. Materials and Methods: Data were from Alabama Medicaid delivery claims in 2017. Bivariate analyses were used to examine maternal characteristics by HDP diagnosis. Hierarchical generalized linear models, with observations nested at the county level, were used to assess multivariable relationships between maternal characteristics and HDP diagnosis. Results: Among women with HDP diagnosis, a higher proportion were older, Black, had other comorbidities, and had more perinatal hospitalizations or emergency visits compared with those without HDP diagnosis. There were increased odds of an HDP diagnosis for older women and those with comorbidities. Black women (adjusted odds ratio aOR = 1.24, 95% confidence interval CI: 1.16–1.33), women insured only during pregnancy by Sixth Omnibus Reconciliation Act Medicaid (aOR = 1.08, 95% CI: 1.02–1.15), and women entering prenatal care (PNC) in the second trimester (aOR = 1.10, 95% CI: 1.03–1.18) had elevated odds of HDP diagnosis compared with their counterparts. Conclusions: Beyond traditional demographic and clinical risk factors, not having preconception insurance coverage or first trimester PNC entry were associated with higher odds of HDP diagnosis. Improving the provision and timing of maternity coverage among Medicaid recipients, particularly in nonexpansion states, may help identify and treat women at risk of HDP and associated adverse perinatal outcomes.
Moore et al. (Fri,) conducted a observational in Hypertensive disorders of pregnancy. Sociodemographic and care utilization characteristics (e.g., Black race, pregnancy-only insurance) vs. Counterparts was evaluated on Hypertensive disorders of pregnancy (HDP) diagnosis (aOR 1.24, 95% CI 1.16-1.33). Black race (aOR 1.24; 95% CI 1.16-1.33), pregnancy-only Medicaid coverage, and second-trimester prenatal care entry were associated with increased odds of hypertensive disorders of pregnancy.