Policy Change and Women's Health

项目摘要 在美国分娩的妇女早产的可能性比加拿大或美国妇女高50%。 英国.美国不良妊娠结局的高发生率随着时间的推移几乎没有改变，尽管 公共卫生和政策方案，旨在增加获得产前护理的机会，努力降低 不良妊娠结局。这种努力的影响相对较小的一种解释是， 护理往往开始得太晚，无法减少诸如吸烟、饮酒、肥胖， 慢性病和意外怀孕人们越来越认识到，改善妇女健康， 是降低不良妊娠结局发生率的关键。最近的一个项目， 改善妇女孕前健康的一个重要措施是2014年医疗补助计划的扩大， 《护理法》（ACA），但仅在某些州通过。该方案增加了获得和利用 可以改善孕前健康的卫生保健服务（即，糖尿病的检测、诊断和治疗 高血压和戒烟处方药）。的 该提案的总体目标是评估ACA医疗补助计划扩展对孕前健康的影响， 生殖健康行为（例如，避孕，意外怀孕和生育），怀孕健康，以及 出生结果。拟议工作的第一个目标是评估2014年医疗补助扩大对 低收入妇女孕前保健利用、健康行为和健康指标 44岁。第二个具体目标是量化医疗补助扩大对生殖健康的影响。 健康行为，包括避孕、意外怀孕和生育。第三个具体目标是 确定在怀孕的妇女中，扩张是否降低了以下概率： 母亲妊娠并发症（妊娠高血压、子痫和妊娠期糖尿病）和2） 不良出生结局（早产和小于胎龄体重）。为了实现我们的目标，我们将 分析几个大型的国家数据源，并利用 2014年医疗补助扩张中的州际差异，以检验为低收入人群提供医疗保险的假设。 怀孕前的高收入妇女可以改善孕前健康，从而减少 妊娠并发症和不良后果。拟议的研究将范式从一个集中在 从主要关注妇女怀孕期间的健康转变为关注孕前健康。的证据 这项拟议中的研究有可能改变公共卫生政策，将覆盖面扩大到低收入人群。 为育龄妇女提供服务，以改善其孕前和怀孕健康，从而减少 早产

PROJECT SUMMARY Women giving birth in the US are 50% more likely to deliver preterm compared to women in Canada or the United Kingdom. The US's high rates of adverse pregnancy outcomes have changed little over time, despite public health and policy programs aimed at increasing access to prenatal care in an effort to reduce rates of adverse pregnancy outcomes. One explanation for the relatively small impact of such efforts is that prenatal care often begins too late to reduce the negative effects of factors such as smoking, alcohol use, obesity, chronic disease, and unintended pregnancy. There is growing recognition that improving women's health prior to conception is key to decreasing rates of adverse pregnancy outcomes. A recent program with the potential to improve women's preconception health is the 2014 Medicaid expansion that occurred under the Affordable Care Act (ACA) but was adopted only in certain states. This program increased access to and utilization of health care services that can improve preconception health (i.e., testing, diagnosis, and treatment for diabetes and high blood pressure and prescription medications for smoking cessation) among low-income adults. The overall goal of this proposal is to assess the impact of the ACA Medicaid expansion on preconception health, reproductive health behaviors (e.g., contraception, unintended pregnancy, and fertility), pregnancy health, and birth outcomes. The first aim of the proposed work is to assess the impacts of the 2014 Medicaid expansion on indicators of preconception health care utilization, health behavior, and health among low-income women 18 to 44 years of age. The second specific aim is to quantify the impact of the Medicaid expansion on reproductive health behaviors including contraception, unintended pregnancy, and fertility. The third specific aim is to ascertain, among women who become pregnant, whether the expansion decreased the probability of 1) maternal pregnancy complications (pregnancy hypertension, eclampsia, and gestational diabetes) and 2) adverse birth outcomes (preterm birth and small weight for gestational age). To achieve our aims, we will link and analyze several large, national data sources and take advantage of the unique opportunity afforded by the inter-state variation in 2014 Medicaid expansion to test the hypothesis that providing health insurance to low income women prior to conception can improve preconception health and thus reduce the prevalence of pregnancy complications and adverse outcomes. The proposed research shifts the paradigm from one focused primarily on women's health during pregnancy to one focused on health prior to pregnancy. The evidence from the proposed research has the potential to shift public health policy toward expanding coverage to low income women of reproductive age in order to improve their preconception and pregnancy health, and thereby reduce preterm birth.