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The number of women who had Medicaid in the month before pregnancy rose from 31 percent to 36 percent in states that opted out of Medicaid expansion, but increased from 43 percent to 57 percent in states that expanded Medicaid, the researchers found. Expanded Medicaid coverage became available in many states in 2014 as part of the Affordable Care Act (also known as the ACA, or Obamacare).
"Higher rates of health insurance before pregnancy may improve access to preconception care, which can help women to appropriately plan their pregnancy and optimize their health before conceiving," said study co-author Jamie Daw. She's an assistant professor of health policy and management at the Columbia University Mailman School of Public Health in New York City.
"Interventions in the preconception period -- such as disease screening, disease management and exposure avoidance counseling -- reduce pregnancy risks and are associated with improved maternal and fetal outcomes," Daw added in a Columbia news release.
For the study, Daw and her colleagues focused on women with family incomes at 138 percent of the federal poverty level or less, who took part in the Pregnancy Risk Assessment Monitoring System from 2009 to 2015.
The researchers concentrated on nearly 30,500 women from eight states with expanded Medicaid, and about 26,500 women from seven states without it.
Daw's team found that nearly half of the increase in Medicaid coverage was among women who lost their private health insurance. The other half was among uninsured women. Earlier research found that before the ACA was passed, more than half of women with pregnancy-related Medicaid were uninsured before pregnancy.
"The U.S. has the highest maternal and infant mortality rate among high-income countries," Daw said. "More research is needed to explore the extent to which the increases in preconception Medicaid found in this study led to improvements in health outcomes for mothers and children."
The report was published online recently in the Journal of Obstetrics & Gynecology.
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