Prenatal Care and Birth Outcomes

Posted on | December 10, 2007 | 1 Comment

Does Continuous Coverage Make Sense?

The cost associated with premature birth and low birth weight babies is astounding. According to a 2007 study in Pediatrics, the annual cost of hospitalization for premature/low birth weight babies in the United States during 2001 was $5.8 billion. This cost reflects 47% of all infant hospitalizations in that year and 27% of all pediatric stays. This cost was for the hospital stay alone. It does not figure in the cost for the ongoing medical, educational and ancillary services associated with these babies. The individual cost associated with preterm/low birth weigh births is $15,100, with an average hospital length of stay of 12.9 days. In contrast, the average hospital cost for newborns without complications is $600 dollars with an average length of stay of 1.9 days.

Preterm/low birth weight babies are at increased risk for impaired neurological and cognitive functioning and poor educational success. As the birth weight and gestational age of these babies decreases so does the prognosis for positive outcomes. Although advancements in technology enable us to keep very low birth weight babies alive it is not a panacea for this problem nor is it a substitute for the inter-uterine fetal growth and development associated with full gestational age and normal birth weight. Given the poor developmental outcomes associated with preterm/low birth weight babies and the related cost to multiple systems, preventing preterm/low birth weight births should be a priority.

Early entry into prenatal care and receiving the adequate number of prenatal visits has been associated with positive birth outcomes. Women who are insured prior to becoming pregnant are more likely to achieve this goal. According to the Association of State and Territorial Health Officials in its report on State Policy to Improve Birth Outcomes: “Access to health insurance coverage is a critical component of assuring healthy birth outcomes for women and infants. A lack of health insurance often means late or no entry into prenatal care for women, which can lead to a host of pregnancy complications and delayed diagnosis of treatable conditions. Specifically, uninsured pregnant women are less likely to initiate prenatal care in their first trimester and are more likely to report receiving less than 80% of the number of recommended prenatal visits than insured women.”

Known risk factors for preterm birth/low birth weight include maternal behaviors such as smoking, medical conditions such as hypertension and diabetes and conditions such as stress, depression and domestic violence — which impact a pregnant woman’s emotional and psychological health. Many known risk factors for adverse birth outcomes can be identified and treated during pregnancy, thus mediating their negative impact on birth outcomes. When women have insurance prior to becoming pregnant they are able to receive preconception care. Preconception care can facilitate the adoption of a healthy life style and during preconception care visits interventions existing health problems can be offered. For example, adequate folic acid intake is essential in preventing neural tube defect. All pregnant women are advised to take prenatal vitamins containing the recommended dose of folic acid. However, adequate folic acid intake prior to pregnancy is as essential as during pregnancy.

In 2006 a Centers for Disease Control and Prevention Select Panel on Preconception Care outlined four goals to achieve the vision of improved health and pregnancy outcomes in the United States. These include ensuring that all U.S. women of childbearing age receive preconception care services that will promote optimal health when they enter pregnancy and reduce risks identified in a prior adverse pregnancy outcome through access to health services in the inter-pregnancy period.

Access to health insurance for women of childbearing age before, during and after pregnancy is critical to achieving these CDC goals. The concept of “continuous coverage” lends itself as a solution towards ensuring that women receive early entry and adequate prenatal and postpartum care. Continuous coverage will also prepare women of childbearing age to adopt healthy behaviors before becoming pregnant and to have affordable preconception care and family planning services. A 2007 study by Rosenenberg et al. suggests that pre-pregnancy Medicaid coverage is associated with early entry into prenatal care. Results reveal that 70% of women with Medicaid at the onset of pregnancy enter prenatal care during the first trimester of pregnancy compared to only 47.3% of those who are eligible but without insurance at the onset of pregnancy. Continuous insurance coverage after birth (i.e., during the inter-conception period) provides an opportunity for wellness and family planning services, interventions for changing lifestyle behaviors such as smoking, substance abuse, poor nutrition and obesity and management of chronic health problems all of which are related to poor birth outcomes and facilitate a women’s ability to enter prenatal care in an optimal healthy state.

While the business of health care struggles to keep costs down, prenatal care and wellness services for women during childbearing age are an ounce of prevention. With the staggering cost each year associated with adverse birth outcomes, preventing these outcomes should be a priority. As it is better to be penny-wise than pound-foolish, continuous coverage not only makes sense, it makes good dollars and cents.

To learn more about continuous coverage, visit the Commonwealth Fund website.

(Amy Gagliardi is a writer and researcher based at Yale University. She can be reached at [email protected]. Opinions expressed by Health Commentary guest bloggers do not necessarily represent the views of Health Commentary.)

Category: Amy Gagliardi, motherhood, public health

Comments

One Response to “Prenatal Care and Birth Outcomes”

Healthy Moms Mag
April 21st, 2017 @ 3:16 pm

Great information on recommended vitamins for pregnant women. This is the first time I have visited your site. Thanks for sharing! Have a terrific day!