Adverse Maternal Outcomes for Women with Different Health Insurance Statuses in Nevada

Objective. Nevada women with unfavorable health insurance status may face greater barriers than women in the rest of the nation, since the development of healthcare infrastructure in Nevada is running behind population growth. This study examines the relationship between health insurance status and adverse maternal outcomes in Nevada. Methods. Hospital discharge information of 33,149 women aged 13 or older who delivered in 2004 was abstracted from the 2004 State Inpatient Data for Nevada. A total of 13 measures of complications associated with pregnancy were identified, including preterm labor, hypertensive disorders of pregnancy, gestational diabetes, ante-partum hemorrhage, membrane disorders, cesarean section, prolonged labor, postpartum hemorrhage, and fetal death. Multiple logistic regression was applied for data analysis. Results. As compared to women covered by private insurance, women with Medicaid were more likely to have abruptio placenta (OR [95% confidence interval (CI)] 1.67 [1.24, 2.26]), prolonged labor (OR [CI] 1.16 [1.03, 1.31]), and fetal death (OR [CI] 1.59 [1.11, 2.27]). Uninsured women had a higher risk of having prolonged labor (OR [CI] 1.20 [1.01, 1.42]) and fetal death (OR [CI] 1.70 [1.05, 2.74]), but had a lower risk of experiencing pre-eclampsia (OR [CI] 0.72 [0.53, 0.98]), pregnancy-induced hypertension (OR [CI] 0.70 [0.56, 0.88]), gestational diabetes (OR [CI] 0.75 [0.57, 0.98]), and a cesarean section (OR [CI] 0.69 [0.62, 0.77]). Conclusion. Policies promoting prenatal care and case management programs for female Medicaid recipients can help to reduce the risk of maternal complications. Joint efforts by policy makers, public health advocates, social support groups, and health care practitioners to offer integrated programs to help both Medicaid and uninsured women are likely to succeed in improving maternal outcomes