Neighborhood Deprivation and Timely Entry into Prenatal Care, Risk Screening, and Receipt of Care Management Services Among High-Risk Pregnant Medicaid Enrollees in North Carolina

Background: Hypertensive disorders of pregnancy disproportionately impact Black women, contributing to higher morbidity and mortality. Neighborhood deprivation provides insights, as Black families often face hindered access to health care. This study examines the link between neighborhood deprivation and access to prenatal services for high-risk pregnant individuals in North Carolina’s Medicaid-managed Pregnancy Medicaid Homes (PMH). Methods: Dataset included Medicaid claims, birth certificate, risk screening, care management, and American Community Survey data from January 2017 to February 2020. We used multivariate logistic regression models to estimate the relationship between timely prenatal care entry, risk screening, and face-to-face care management and Indices of Concentration of the Extremes for race and income, categorized into quintiles from 1 (most deprived) to 5 (most privileged). Analysis included 53,000 pregnant individuals with ≥1 preeclampsia risk factor. Results: We found that those from the most deprived neighborhoods had an 11.1 (standard error [SE]: 0.023; 0.0000), 4.1 (SE: 0.014; 0.000), and 8.0 (SE: 0.013; 0.000) percentage points lower likelihood of timely prenatal care entry, risk screening, and care management, respectively, compared with those from the most privileged neighborhoods. Conversely, non-Hispanic Black (NHB) individuals in the least privileged neighborhoods demonstrated a higher likelihood of timely prenatal care entry and care management compared with their non-Hispanic White peers. Conclusions: This study reveals that neighborhood deprivation limits access to prenatal care, risk screening, and care management. Although NHB pregnant individuals have slightly better access, likely due to initiatives such as the PMH, deprivation remains a significant barrier. Addressing these disparities requires equity-focused interventions to ensure that all pregnant individuals receive timely prenatal services.