Pre-pregnancy and Early Prenatal Care are Associated with Lower Risk of Ectopic Pregnancy Complications in the Medicaid Population: 2004-08

Paediatr Perinat Epidemiol. 2017 Jan;31(1):4-10. doi: 10.1111/ppe.12327. Epub 2016 Nov 16.


Background: Ectopic pregnancy causes significant maternal morbidity and mortality. Complications are more common among women with Medicaid or no insurance compared to those with private insurance. It is unknown whether preventive care prior to pregnancy and prenatal care, which are covered by Medicaid, would decrease complications if they were more fully utilised.

Methods: Medicaid claims were used to identify a clinical cohort of women who experienced an ectopic pregnancy during 2004-08 among all female Medicaid enrolees from a large 14-state population, ages 15-44. Diagnosis and procedure codes were used to identify ectopic pregnancies and associated complications. The primary outcomes were complications associated with ectopic pregnancy: blood transfusion, sterilisation, or hospitalisation with length of stay greater than 2 days. Independent variables were documentation of preventive care within 1 year prior to the ectopic pregnancy and prenatal care within 4 months prior.

Results: Controlling for race, age, and state of residence, women's risks of any ectopic pregnancy complication were independently higher among those who did not receive any Medicaid-covered preventive care within 1 year before the ectopic pregnancy compared to those who did (RR 1.12, 95% confidence interval (CI) 1.09, 1.16), and among those who did not receive any Medicaid-covered prenatal care within 4 months prior, compared to those who did (RR 1.89, 95% CI 1.83, 1.96).

Conclusions: Pre-pregnancy and prenatal care are independently associated with decreased risk of ectopic pregnancy complications among Medicaid beneficiaries.

Keywords: ectopic pregnancy; insurance status; preconception care; prenatal care.

MeSH terms

  • Adolescent
  • Adult
  • Blood Transfusion / economics
  • Blood Transfusion / statistics & numerical data
  • Female
  • Healthcare Disparities / statistics & numerical data
  • Humans
  • Incidence
  • Insurance Coverage / statistics & numerical data
  • Length of Stay / economics
  • Length of Stay / statistics & numerical data
  • Medicaid / statistics & numerical data*
  • Medically Uninsured / statistics & numerical data
  • Obstetric Surgical Procedures / economics
  • Obstetric Surgical Procedures / statistics & numerical data
  • Pregnancy
  • Pregnancy, Ectopic / economics
  • Pregnancy, Ectopic / epidemiology*
  • Pregnancy, Ectopic / prevention & control*
  • Pregnancy, Ectopic / therapy
  • Prenatal Care / economics
  • Prenatal Care / standards
  • Prenatal Care / statistics & numerical data*
  • Retrospective Studies
  • Socioeconomic Factors
  • United States / epidemiology
  • Young Adult