Siddika Nazeeba, Hettinger Katlyn, Margerison Claire E
Department of Epidemiology and Biostatistics, Michigan State University, Fee Hall West Wing; 909 Wilson Rd, East Lansing, MI, 48824, USA.
Department of Oral Health Sciences, College of Dental Medicine; Lincoln Memorial University, 1705 St Mary St, Knoxville, TN, 37917, USA.
Matern Child Health J. 2025 Feb;29(2):217-224. doi: 10.1007/s10995-025-04041-6. Epub 2025 Jan 27.
Dental care before pregnancy is critical for preventing poor oral health, which is associated with adverse pregnancy outcomes. People with low incomes, however, may face insurance-related barriers to obtaining dental care. Medicaid expansion under the Affordable Care Act increased access to dental care utilization among adults with low incomes. However, little is known about the impact of Medicaid policies on pre-pregnancy dental care utilization.
To evaluate the impacts on pre-pregnancy dental care utilization of two aspects of Medicaid policy: (1) state level of Medicaid dental coverage and (2) Medicaid expansion overall and by state level of dental coverage.
We used data from Pregnancy Risk Assessment Monitoring System (PRAMS) data phases 7 (2012-15) and 8 (2016-18). To examine the association between state level of dental coverage beyond emergency services (i.e., extensive vs. limited) and pre-pregnancy dental care utilization, we conducted an adjusted logistic regression analysis. To evaluate the impact of Medicaid expansion on pre-pregnancy dental care utilization, we conducted a quasi-experimental event study design, which estimates the percentage point difference in the outcome between expansion and non-expansion states at each time period compared to the period just prior to Medicaid expansion.
We found a significant 13% (adjusted odds ratio (OR) = 1.13; 95% CI: 1.05, 1.22) higher odds of pre-pregnancy dental care utilization among the birthing people residing in states that provided extensive dental coverage compared to those in states that provided limited dental coverage. However, Medicaid expansion under the ACA was not associated with pre-pregnancy dental care utilization overall or among either states with extensive or limited Medicaid dental coverage.
怀孕前的口腔护理对于预防不良口腔健康状况至关重要，而不良口腔健康状况与不良妊娠结局相关。然而，低收入人群在获得口腔护理方面可能面临与保险相关的障碍。《平价医疗法案》下的医疗补助计划扩大，增加了低收入成年人获得口腔护理服务的机会。然而，对于医疗补助政策对怀孕前口腔护理服务利用的影响知之甚少。
评估医疗补助政策两个方面对怀孕前口腔护理服务利用的影响：（1）州级医疗补助口腔保险覆盖范围；（2）总体医疗补助计划扩大情况以及按州级口腔保险覆盖范围划分的情况。
我们使用了来自妊娠风险评估监测系统（PRAMS）第7阶段（2012 - 2015年）和第8阶段（2016 - 2018年）的数据。为了研究除急诊服务外的州级口腔保险覆盖范围（即广泛覆盖与有限覆盖）与怀孕前口腔护理服务利用之间的关联，我们进行了调整后的逻辑回归分析。为了评估医疗补助计划扩大对怀孕前口腔护理服务利用的影响，我们进行了一项准实验性事件研究设计，该设计估计了在每个时间段，与医疗补助计划扩大前的时期相比，扩大州和未扩大州在结果上的百分点差异。
我们发现，与口腔保险覆盖范围有限的州的分娩人群相比，居住在提供广泛口腔保险覆盖范围的州的分娩人群怀孕前接受口腔护理服务的几率显著高出13%（调整后的优势比（OR） = 1.13；95%置信区间：1.05，1.22）。然而，《平价医疗法案》下的医疗补助计划扩大与总体怀孕前口腔护理服务利用无关，在医疗补助口腔保险覆盖范围广泛或有限的州中也均无关联。
