Exploring Preconception Care: Insurance Status, Race/Ethnicity, and Health in the Pre-pregnancy Period

Abstract

Objective To measure the association of preconception health insurance status with preconception health among women in New York City, and examine whether this association is modified by race/ethnicity. Methods Using data from the New York City Pregnancy Risk Assessment Monitoring System 2009–2011 (n = 3929), we created a “Preconception Health Score” (PHS) capturing modifiable behaviors, healthcare services utilization, pregnancy intention, and timely entry into prenatal care. We then built multivariable logistic regression models to measure the association of PHS with health insurance status and race/ethnicity. Results We found PHS to be higher among women with private insurance (7.3 ± 0.07) or public insurance (6.3 ± 0.08) before pregnancy than no insurance (5.9 ± 0.09) (p < .001). However, when stratified by race/ethnicity, the positive association of PHS with insurance was absent in the non-white population. Conclusions for Practice Having health insurance during the pre-pregnancy period is associated with greater health among white women, but not among black or Hispanic women in NYC.

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Acknowledgements

This research was supported by NIH/National Center for Advancing Translational Science (NCATS) Einstein-Montefiore CTSA Grant Number TL1TR001072. The authors thank Candace Mulready-Ward and Christina Fiorentini of PRAMS NYC, and the PRAMS working group.

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Correspondence to Rebecca Mahn Hawks.

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The authors declare that they have no conflict of interest.

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Source: Pregnancy Risk Assessment Monitoring System (PRAMS), a surveillance project for the CDC.

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Hawks, R.M., McGinn, A.P., Bernstein, P.S. et al. Exploring Preconception Care: Insurance Status, Race/Ethnicity, and Health in the Pre-pregnancy Period. Matern Child Health J 22, 1103–1110 (2018). https://doi.org/10.1007/s10995-018-2494-1

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Keywords

  • Preconception care
  • Health insurance
  • Health disparities
  • Race