(282) Adverse pregnancy outcomes in a Medicaid population lacking pre-pregnancy claims history

Objective:
Adverse pregnancy outcomes (APOs) are increasing in the US and disparities exist. Management of chronic conditions is critical to reducing the risk of APOs, but people insured by Medicaid experience higher rates of uninsurance and insurance churn, limiting access to care. We used complete maternity episode data to compare outcomes for nulliparous individuals with and without a pre-pregnancy Medicaid claims history.

Study Design:
This cross-sectional analysis used Medicaid claims for nulliparous, Medicaid insured individuals in GA and TX who received care from a virtual medical practice from 2023-2025. We compared patients with no Medicaid claims in the three years prior to pregnancy to those with claims. Outcomes included CS, preterm birth, gestational DM, hypertensive disorders of pregnancy (HDP), severe maternal morbidity, and NICU admission. Rates of chronic conditions before the first prenatal visit (PNV) and at birth were compared. We used multivariate logistic regression to assess the association between a lack of pre-pregnancy claims and adverse outcomes, controlling for sociodemographic and medical factors.

Results:
Of the 4,219 participants, 60% (n=2,490) had no Medicaid claims in the 3 years preceding pregnancy. People with no claims pre-pregnancy had fewer chronic conditions before the first PNV (claims between start of pregnancy and first PNV), fewer chronic conditions at the time of birth, and higher percent change in chronic conditions identified between the two time points (Table 1). Participants with no pre-pregnancy claims were 24% more likely to have a CS (aOR 1.24, 95% CI 1.07, 1.43) and 42% more likely to develop HDP (aOR 1.42, 95% CI 1.21, 1.66) than people with claims pre-pregnancy (Table 2).

Conclusion:
Even though most participants had no claims pre-pregnancy, many were diagnosed with chronic conditions that likely pre-dated pregnancy. We found an association between no pre-pregnancy claims and certain APOs. Evaluation and intervention for chronic conditions before and early in pregnancy may provide an opportunity to reduce the risk for APOs.