Association of Medicaid Expansion Under the Affordable Care Act With Perinatal Care Access and Utilization Among Low-Income Women: A Systematic Review and Meta-analysis

Obstet Gynecol. 2022 Feb 1;139(2):269-276. doi: 10.1097/AOG.0000000000004647.


Objective: To synthesize the empirical research evidence about the association between Medicaid expansion under the Affordable Care Act (ACA) and increasing perinatal care access and utilization among low-income women.

Data sources: We searched MEDLINE through PubMed (1966-present), EMBASE (Ovid), the Cumulative Index to Nursing and Allied Health (1982-present), PAIS Index (ProQuest), Web of Science (1900-present), and the Cochrane Central Register of Controlled Trials. Our review focuses on the association between Medicaid expansion under the ACA and perinatal care access and utilization, which cannot be subjected to randomized controlled trials, therefore was not included in our search.

Methods of study selection: A comprehensive search of the research literature was performed using Covidence. Studies were eligible if they were based on population data and research designs ensuring that the exposure (ie, Medicaid expansion under the ACA) preceded the perinatal care access or utilization outcome, had an appropriate comparison group, presented quantitative data, and examined pregnant or postpartum women. The search in six bibliographic databases returned 1,243 records, with 855 abstracts reviewed, 34 full-text articles screened for eligibility, and nine eligible studies included in the systematic review.

Tabulation, integration, and results: Stata 16 software was used to generate summary estimates, forest plots, funnel plots, and heterogeneity statistics. Random effects modeling based on pooled data revealed that Medicaid expansion was associated with a 6.1% increase in Medicaid enrollment for pregnant women (95% CI 1.3-10.9%) and a 3.3% increase in perinatal care utilization (95% CI 0.2-6.3%).

Conclusion: Medicaid expansion under the ACA is associated with a modest and statistically significant increase in perinatal care access and utilization among low-income women.

Publication types

  • Meta-Analysis
  • Systematic Review

MeSH terms

  • Female
  • Health Services Accessibility*
  • Humans
  • Medicaid*
  • Patient Protection and Affordable Care Act*
  • Perinatal Care*
  • Pregnancy
  • United States