Pre-pregnancy and Early Prenatal Care are Associated with Lower Risk of Ectopic Pregnancy Complications in the Medicaid Population: 2004-08.
BACKGROUND
Ectopic pregnancy causes significant maternal morbidity and mortality. Complications are more common among women with Medicaid or no insurance compared to those with private insurance. It is unknown whether preventive care prior to pregnancy and prenatal care, which are covered by Medicaid, would decrease complications if they were more fully utilised.


METHODS
Medicaid claims were used to identify a clinical cohort of women who experienced an ectopic pregnancy during 2004-08 among all female Medicaid enrolees from a large 14-state population, ages 15-44. Diagnosis and procedure codes were used to identify ectopic pregnancies and associated complications. The primary outcomes were complications associated with ectopic pregnancy: blood transfusion, sterilisation, or hospitalisation with length of stay greater than 2 days. Independent variables were documentation of preventive care within 1 year prior to the ectopic pregnancy and prenatal care within 4 months prior.


RESULTS
Controlling for race, age, and state of residence, women's risks of any ectopic pregnancy complication were independently higher among those who did not receive any Medicaid-covered preventive care within 1 year before the ectopic pregnancy compared to those who did (RR 1.12, 95% confidence interval (CI) 1.09, 1.16), and among those who did not receive any Medicaid-covered prenatal care within 4 months prior, compared to those who did (RR 1.89, 95% CI 1.83, 1.96).


CONCLUSIONS
Pre-pregnancy and prenatal care are independently associated with decreased risk of ectopic pregnancy complications among Medicaid beneficiaries.
['Stulberg|Debra B|DB|', 'Cain|Loretta|L|', 'Hasham Dahlquist|Irma|I|', 'Lauderdale|Diane S|DS|']
D000293:Adolescent D000328:Adult D001803:Blood Transfusion D005260:Female D054625:Healthcare Disparities D006801:Humans D015994:Incidence D019458:Insurance Coverage D007902:Length of Stay D008484:Medicaid D017057:Medically Uninsured D013513:Obstetric Surgical Procedures D011247:Pregnancy D011271:Pregnancy, Ectopic D011295:Prenatal Care D012189:Retrospective Studies D012959:Socioeconomic Factors D014481:United States D055815:Young Adult
prenatal care ectopic pregnancy insurance status preconception care