Division of Neonatal and Developmental Medicine, Department of Pediatrics, Stanford University School of Medicine, Stanford, California, USA; Clinical Epidemiology Division, Department of Medicine, Solna, Karolinska Institutet, Stockholm, Sweden.
School of Public Health, Oregon Health & Science University, Portland State University, Portland, Oregon, USA.
Womens Health Issues. 2022 May-Jun;32(3):226-234. doi: 10.1016/j.whi.2021.12.004. Epub 2022 Jan 10.
Medicaid expansion under the Affordable Care Act (ACA) improved access to reproductive health care for low-income women and birthing people who were previously ineligible for Medicaid. We aimed to evaluate if the expansion affected the risk of having a short interpregnancy interval (IPI), a preventable risk factor for adverse pregnancy outcomes.
We evaluated parous singleton births to mothers aged 19 or older from U.S. birth certificate data 2009-2018. We estimated the effect of residing in a state that expanded Medicaid access (expansion status determined at 60 days after the prior live birth) on the risk of having a short IPI (<12 months) using difference-in-differences (DID) methods in linear probability models. We stratified the analyses by maternal characteristics and county-level reproductive health care access.
Overall risk of short IPI was 14.9% in expansion states and 16.3% in non-expansion states. The expansion was not associated with a significant change in risk of having a short IPI (adjusted mean percentage point change 1.24 [-1.64, 4.12]). Stratified results also did not provide support for an association.
ACA Medicaid expansion did not have an impact on risk of short IPI. Preventing short IPI may require more comprehensive policy interventions in addition to health care access.
平价医疗法案（ACA）下的医疗补助计划扩大了范围，使以前没有资格获得医疗补助的低收入妇女和分娩者能够获得生殖保健服务。我们旨在评估该扩展是否会影响短孕期间隔（IPI）的风险，这是不良妊娠结局的一个可预防的危险因素。
我们利用美国出生证明数据 2009-2018 年期间的单胎活产母亲年龄在 19 岁及以上的产妇数据进行评估。我们使用线性概率模型中的差分法（DID）方法，估计居住在扩大医疗补助覆盖范围的州（在之前的活产后 60 天确定扩大状态）对短 IPI（<12 个月）风险的影响。我们根据产妇特征和县级生殖保健服务可及性对分析进行分层。
在扩大州，短 IPI 的总体风险为 14.9%，在非扩大州为 16.3%。扩大范围与短 IPI 风险的显著变化无关（调整后的平均百分比变化 1.24[-1.64, 4.12]）。分层结果也没有提供支持关联的证据。
ACA 医疗补助计划的扩大并没有对短 IPI 的风险产生影响。除了获得医疗保健服务外，预防短 IPI 可能需要更全面的政策干预。
