Author Interviews, JAMA, OBGYNE, Pediatrics, Race/Ethnic Diversity / 24.04.2019
How Did Medicaid Expansion Affect Low Birth Weights and Preterm Births?
MedicalResearch.com Interview with:
[caption id="attachment_48728" align="alignleft" width="123"] Dr. Brown[/caption]
Clare Brown, PhD
Health Systems and Services Research
University of Arkansas for Medical Sciences
[caption id="attachment_48727" align="alignleft" width="125"]
Dr. Tilford[/caption]
J. Mick Tilford, PhD,
Professor and Chair
Department of Health Policy and Management
Fay W. Boozman College of Public Health
University of Arkansas for Medical Science
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: Prematurity and low birthweight are associated with increased risk of infant mortality as well as increased risk of chronic conditions throughout infancy and into adulthood. Non-Hispanic black infants are twice as likely to be born low birthweight (13.9% vs 7.0%) and 1.5 times as likely to be born prematurely (13.9% vs 9.1%) compared to non-Hispanic white infants.
Under the Affordable Care Act (ACA), states may expand Medicaid to adults with household income levels at or below 138% of the federal poverty level, thus extending coverage to childless adults and improving continuity. Insurance gain may ultimately improve maternal health, increased use and earlier initiation of prenatal care services, and improved access to pregnancy planning resources.
Our study aimed to evaluate whether there were changes in rates of low birthweight and preterm birth outcomes among states that expanded Medicaid versus states that did not expand Medicaid.
Dr. Brown[/caption]
Clare Brown, PhD
Health Systems and Services Research
University of Arkansas for Medical Sciences
[caption id="attachment_48727" align="alignleft" width="125"] Dr. Tilford[/caption]
J. Mick Tilford, PhD,
Professor and Chair
Department of Health Policy and Management
Fay W. Boozman College of Public Health
University of Arkansas for Medical Science
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: Prematurity and low birthweight are associated with increased risk of infant mortality as well as increased risk of chronic conditions throughout infancy and into adulthood. Non-Hispanic black infants are twice as likely to be born low birthweight (13.9% vs 7.0%) and 1.5 times as likely to be born prematurely (13.9% vs 9.1%) compared to non-Hispanic white infants.
Under the Affordable Care Act (ACA), states may expand Medicaid to adults with household income levels at or below 138% of the federal poverty level, thus extending coverage to childless adults and improving continuity. Insurance gain may ultimately improve maternal health, increased use and earlier initiation of prenatal care services, and improved access to pregnancy planning resources.
Our study aimed to evaluate whether there were changes in rates of low birthweight and preterm birth outcomes among states that expanded Medicaid versus states that did not expand Medicaid.
Dr. Rood[/caption]
Dr. Kara Rood MD
Maternal-fetal Medicine Physician
The Ohio State University Wexner Medical Center
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: This is a simple, rapid, non-invasive test for early recognition of preeclampsia.
MedicalResearch.com: What should readers take away from your report?
Response: Aid in timely diagnosis to help provide closer observations to pregnancies with complicated by preeclampsia, to prevent the devastating adverse pregnancies outcomes for mom's and babies that can occur when pregnancies become complicated by preeclampsia.
Dr. Gyamfi-Bannerman[/caption]
Cynthia Gyamfi-Bannerman, MD, MSc
Ellen Jacobson Levine and Eugene Jacobson
Professor of Women's Health in Obstetrics and Gynecology
Director, Maternal-Fetal Medicine Fellowship Program
Co-Director, CUMC Preterm Birth Prevention Center
Columbia University
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: In 2016 our group published the findings of the Antenatal Late Preterm Steroids (ALPS) trial in the NEJM. We found that administration of antenatal corticosteroids to women at high risk for delivery from 34-36 weeks decreased breathing problems in their neonates. This treatment had been traditionally only given at less than 34 weeks.
The current paper is a cost analysis of that trial. We found that the treatment was also cost effective. From a cost perspective treatment was both low cost and highly effective (the options are low cost, low effect/low cost/high effect, high cost/low effect, high cost/high effect). 
Dr. Kitchener[/caption]
Professor Henry Kitchener, MD FRCOG FRCS
University of Manchester, Manchester, UK
MedicalResearch.com: What is the background for this study?
Response: We now have reliable and affordable technologies to detect human papillomavirus (HPV), a virus which is universally accepted as the cause of cervical cancer. Various large trials confirmed that cervical screening could be improved by replacing the smear (cytology) test that has been in use for decades, with HPV testing. Many countries are now making the switch. In England, this is planned for the end of 2019. To test how to run HPV testing within the English National Health Service, a pilot was initiated in 2013 in six screening laboratories. We also wanted to determine whether the encouraging findings from the trials could be translated to everyday practice. This is important not only because we will be using different HPV tests, but also because women undergoing screening in trials are much more selected than those who are invited to population-based screening. 
Dr. Lischke[/caption]
Dr. Alexander Lischke, Dipl.-Psych.
Universität Greifswald
Institut für Psychologie
Physiologische und Klinische Psychologie/Psychotherapie
University of Greifswald, Germany
MedicalResearch.com: What is the background for this study?
Response: We know for a long time that cyclic variations in womens' estrogen and progesterone levels affect their emotion recognition abilities by modulating neural activity in brain regions implicated in emotion processing. We also know that oral contraceptives suppress cyclic variations in womens' estrogen and progesterone levels. We, thus, assumed that oral contraceptives would affect womens' emotion recognition abilities due to the aforementioned suppression of cylic variations in estrogen and progesterone levels that modulate neural activity in brain regions during emotion processing. To test this assumption, at least with respect to the behavioral effects of oral contraceptive use on emotion recognition, we performed the current study.
We recruited regular cylcling women with and without oral contraceptive use for our study. None of the women were in psychotherapeutical or psychopharmacological treatment at the time of the study. During the study, women performed a emotion recognition task that required the recognition of complex emotional expressions like, for example, pride or contempt.
Dr. Dayan[/caption]
Natalie Dayan MD MSc FRCPC
General Internal Medicine and Obstetric Medicine,
Clinician-Scientist, Research Institute
Centre for Outcomes Research and Evaluation (CORE)
McGill University Health Centre
Montréal QC
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: Infertility treatment is rising in use and has been linked with maternal and perinatal complications in pregnancy, but the extent to which it is associated with severe maternal morbidity (SMM), a composite outcome of public health importance, has been less well studied. In addition, whether the effect is due to treatment or to maternal factors is unclear.
We conducted a propensity matched cohort study in Ontario between 2006 and 2012. We included 11 546 women who had an infertility-treated pregnancy and a singleton live or stillborn delivery beyond 20 weeks. Each woman exposed to infertility treatment was then matched using a propensity score to approximately 5 untreated pregnancies (n=47 553) in order to address confounding by indication. Poisson regression revealed on overall 40% increase in the risk of a composite of SMM (one of 44 previously validated indicators using ICD-10CA codes and CCI procedure codes) (30.3 per 1000 births vs. 22.8 per 1000 births, adjusted relative risk 1.39, 95% CI 1.23-1.56). When stratified according to invasive (eg., IVF) and non-invasive treatments (eg. IUI or pharmacological ovulation induction), women who were treated with IVF had an elevated risk of having any severe maternal morbidity, and of having 3 or more SMM indicators (adjusted odds ratio 2.28, 95% CI 1.56 – 3.33), when compared with untreated women, whereas women who were treated with non-invasive treatments had no increase in these risks.
