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Policy Change and Women's Health

政策变化与妇女健康

基本信息

批准号：
10640126
负责人：
Claire E Margerison
金额：
$ 38.19万
依托单位：
MICHIGAN STATE UNIVERSITY
依托单位国家：
美国
项目类别：
财政年份：
2019
资助国家：
美国
起止时间：
2019-06-15 至 2024-05-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/10640126
关键词：
Adopted Adult Affect Affordable Care Act Age Age Years Alcohol consumption Birth Birth Records Body mass index Canada Chronic Disease Conceptions Contraceptive Agents Contraceptive methods Data Data Sources Developed Countries Diabetes Mellitus Diagnosis Disease Management Disparate Disparity Drug Prescriptions Eclampsia Eligibility Determination Family Fertility Gestational Age Gestational Diabetes Goals Growth Health Health Insurance Health Policy Health Professional Health behavior Hypertension Infant Infant Health Insurance Insurance Coverage Intake Knowledge Link Low income Medicaid Monitor National Health Interview Survey Obesity Outcome Phase Physical activity Policies Preconception Care Pregnancy Pregnancy Complications Pregnancy Outcome Pregnant Women Premature Birth Prenatal care Prevalence Preventive care Preventive healthcare Probability Public Health Public Policy Publications Quasi-experiment Reproductive Health Research Research Design Risk Risk Factors Risk Reduction Smoking Source Surveys System Testing Time United Kingdom Unmarried Variant Vital Statistics Vitamins Weight Woman Women&apos s Health Work adverse birth outcomes adverse outcome adverse pregnancy outcome clinical practice disease diagnosis health care delivery health care service utilization healthy pregnancy improved innovation novel nutrition pregnancy health pregnancy hypertension pregnant prenatal programs public health research reproductive smoking cessation unintended pregnancy

项目摘要

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.

项目总结与加拿大或美国的女性相比，美国女性早产的可能性高出50% 英国。美国不良妊娠结局的高比率随着时间的推移变化不大，尽管公共卫生和政策方案，旨在增加获得产前护理的机会，以努力降低不良妊娠结局。这种努力的影响相对较小的一个解释是，产前护理往往开始得太晚，无法减少吸烟、饮酒、肥胖、慢性病和意外怀孕。越来越多的人认识到，改善妇女的健康优先怀孕是降低不良妊娠结局的关键。最近一个有潜力的节目改善女性先入为主的健康是2014年医疗补助计划的扩大，该计划是在平价医疗计划下进行的《关爱法案》(ACA)，但仅在某些州通过。该计划增加了对可以改善先入为主的健康(即糖尿病的检测、诊断和治疗)的卫生保健服务以及高血压和戒烟处方药)。这个这项提案的总体目标是评估ACA医疗补助扩大对怀孕前健康的影响，生殖健康行为(如避孕、意外怀孕和生育)、怀孕健康和出生结局。拟议工作的第一个目标是评估2014年医疗补助扩大对 18至18岁低收入妇女的先入为主的卫生保健利用、健康行为和健康指标现年44岁。第二个具体目标是量化医疗补助扩大对生殖的影响健康行为，包括避孕、意外怀孕和生育。第三个具体目标是在怀孕的女性中，确定扩张是否降低了1) 孕产妇妊娠并发症(妊娠高血压综合征、子痫和妊娠期糖尿病)和2) 不良分娩结局(早产和胎龄体重过轻)。为了实现我们的目标，我们将并分析几个大型的国家数据源，并利用 2014年医疗补助计划扩展的州际差异，以检验向低收入人群提供医疗保险的假设怀孕前有收入的妇女可以改善怀孕前的健康状况，从而降低患病率妊娠并发症和不良结局。拟议中的研究将范式从专注于从主要关注怀孕期间的妇女健康转变为关注怀孕前的健康。证据来自这项拟议中的研究有可能将公共卫生政策转向将覆盖范围扩大到低收入人群育龄妇女，以改善她们的成见和妊娠健康，从而减少早产。

项目成果

期刊论文数量（10）

专著数量（0）

科研奖励数量（0）

会议论文数量（0）

专利数量（0）

Medicaid Expansion Associated With Some Improvements In Perinatal Mental Health.

DOI：
10.1377/hlthaff.2021.00776
发表时间：
2021-10
期刊：
HEALTH AFFAIRS
影响因子：
9.7
作者：
Margerison, Claire E.;Hettinger, Katlyn;Kaestner, Robert;Goldman-Mellor, Sidra;Gartner, Danielle
通讯作者：
Gartner, Danielle

Margerison et al. Respond to "Medicaid Policy and Reproductive Autonomy".

马杰里森等人。