Pam Harrison

May 12, 2017


SAN DIEGO — Early numbers suggest that insurance coverage under the Affordable Care Act prompted more women to seek hastier first-trimester care, which resulted in better outcomes, according to research presented here at the American College of Obstetricians and Gynecologists (ACOG) 2017 Annual Meeting.

"Our study showed that when more women were covered by insurance, we saw more patients earlier in the first trimester," reported Roshanda Mitchell, MD, from Howard University Hospital in Washington, DC. "There was a decrease in maternal mortality after the Affordable Care Act was implemented as well."

In the absence of insurance, women typically have to apply for Medicaid coverage, Dr Mitchell pointed out. "Most women don't find out that they are pregnant until maybe 6 weeks after they get pregnant, and then they have to go through the process of applying for Medicaid. This can take a good month, and they can't be seen without an insurance card," she told Medscape Medical News.

"As a provider, we see this all the time — women tell us they wanted to come in earlier but didn't because they did not have insurance coverage," she explained.

Indeed, this was the impetus for Dr Mitchell and her colleagues to study whether or not the Affordable Care Act made a difference in how early women came in for prenatal care, and whether earlier care improved maternal mortality rates.

Researchers used state-level data from the Census Bureau and the Centers for Disease Control and Prevention from 39 states to try to answer this question.

High Maternal Mortality Rate

In 2014, the year the Affordable Care Act was implemented, the maternal mortality rate in the United States was 22.0 deaths per 100,000 — the worse such rate among high-income countries.

The World Health Organization attributes this in part to inadequate prenatal supervision.

Dr Lisa Hollier

There are many reasons maternal mortality rates are so high, beyond prenatal care, said Lisa Hollier, MD, who is president-elect of the ACOG and chair of the Texas Maternal Mortality and Morbidity Task Force.

"One of the things we did in Texas was identify women who had a death within a year of the end of their pregnancy, and we looked back and compared them with women who survived," she told Medscape Medical News.

One of the risk factors they identified was late prenatal care, which was more common among women who died than among those who did not.

"And when we evaluate factors that delay the onset of prenatal care for women, the most common factors are related to their healthcare coverage and insurance; it can be a long process," she added.

"Being able to identify potentially modifiable risk factors early on gives us an opportunity to partner with the woman and help her achieve better pregnancy outcomes," Dr Hollier explained.

Mortality rates continue to rise in most states, Dr Hollier pointed out, and the disparity in maternal mortality rates between black and white women continues to increase, even in California, where death rates dropped after the state earmarked the issue as a key priority.

Every study shows that prenatal care contributes to improved maternal survival and fetal well-being.

"Every study shows that prenatal care contributes to improved maternal survival and fetal well-being," noted Jennifer Blake, chief executive officer of the Society of Obstetricians and Gynaecologists of Canada.

The maternal mortality rate in Canada is about half that of the United States. "Prenatal care is one of the best investments a society can make. I hope that the US will retain important elements of good women's healthcare, including prenatal care," she said.

The ACOG will be working hard to ensure that women will have full access to quality care under the new administration in the United States, Dr Hollier reported.

"Maternity healthcare was considered to be one of the essential health benefits in the Affordable Care Act. Being able to have maternity care coverage for all women is incredibly important and something we're very concerned that women could lose," Dr Hollier told Medscape Medical News. "It's a big job ahead."

Dr Mitchell, Dr Hollier, and Dr Blake have disclosed no relevant financial relationships.

American College of Obstetricians and Gynecologists (ACOG) 2017 Annual Meeting: Abstract 21J. Presented May 7, 2017.

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