Teenage Pregnancy Insurance Access,Outcome Disparities,and State Medicaid Expansion

Abstract

Teenagers who give birth in the United States have known risks for morbidity. This population often has limited access to care. This study examined the association of state Medicaid expansion with insurance attainment, adequate prenatal care, maternal hypertension, and maternal diabetes, and investigated racial and ethnic disparities, using a cross-sectional 2019 national database. Multivariable logistic regression analyses were performed. Teenagers in Medicaid expansion states were more likely to acquire insurance during pregnancy (P < .001). State Medicaid expansion status was not associated with prenatal care adequacy, maternal hypertension, or diabetes, but significant racial/ethnic disparities existed. Compared with non-Hispanic white teenagers, non-Hispanic black teenagers had increased odds of inadequate prenatal care (odds ratio [OR] = 1.77, 95% confidence interval [CI] = 1.02, 3.05) and hypertension (OR = 2.18, 95% CI = 1.23, 3.86), and Hispanic teenagers had increased odds of diabetes (OR = 3.72, 95% CI = 1.05, 13.13). Focused efforts to improve perinatal health among pregnant teenagers are important for this high-risk group.