Policy Change and Women's Health

政策变化与妇女健康

• 批准号: 10174987
• 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
• 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/10174987
• 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; 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; Publications; Quasi-experiment; Reproductive Health; Research; Research Design; Risk; Risk Factors; Smoking; Source; Surveys; System; Testing; Time; United Kingdom; Unmarried; Variant; Vital Statistics; Vitamins; Weight; Woman; Women' 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

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.

项目概要 与加拿大或其他国家的女性相比，在美国分娩的女性早产的可能性高出 50% 英国。尽管美国不良妊娠结局的高发生率随着时间的推移几乎没有变化 公共卫生和政策方案旨在增加获得产前护理的机会，努力降低产前死亡率 不良妊娠结局。这种努力影响相对较小的一种解释是，产前 护理往往开始得太晚，无法减少吸烟、饮酒、肥胖等因素的负面影响， 慢性疾病和意外怀孕。人们越来越认识到，首先要改善妇女的健康 受孕是降低不良妊娠结局发生率的关键。最近的一个项目有潜力 为了改善妇女的孕前健康，2014 年医疗补助计划的扩展是在 Affordable 计划下进行的 《护理法案》(ACA) 但仅在某些州通过。该计划增加了对 可以改善孕前健康的医疗保健服务（即糖尿病的检测、诊断和治疗） 以及低收入成年人的高血压和戒烟处方药）。这 该提案的总体目标是评估 ACA 医疗补助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）、妊娠健康和 出生结果。拟议工作的首要目标是评估 2014 年医疗补助扩展对医疗补助的影响 18 至 18 岁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 确定在怀孕的女性中，扩张是否降低了 1) 的概率 孕产妇妊娠并发症（妊娠高血压、子痫和妊娠糖尿病）和2) 不良的分娩结果（早产和胎龄体重过轻）。为了实现我们的目标，我们将链接 并分析几个大型的国家数据源，并利用 2014 年医疗补助扩展的州际差异检验了向低收入人群提供医疗保险的假设 受孕前有收入的妇女可以改善孕前健康，从而降低患病率 妊娠并发症和不良后果。拟议的研究将范式从单一的集中 重点关注妇女怀孕期间的健康，改为重点关注怀孕前的健康。证据来自 拟议的研究有可能改变公共卫生政策，扩大低收入人群的覆盖范围 育龄妇女，以改善其孕前和孕期健康，从而减少 早产。