WASHINGTON — Neonatal outcomes were the same for uninsured mothers as for those who had health insurance in a study of nearly 8,000 births in Tennessee, Mark F. Sewell, M.D., reported at the annual meeting of the Central Association of Obstetricians and Gynecologists.
Uninsured women were more likely to deliver prematurely, but that did not adversely affect the outcomes of their infants, whose overall morbidity and mortality were comparable with those for the infants of insured mothers, said Dr. Sewell of MetroHealth Medical Center, Cleveland.
Dr. Sewell conducted a secondary analysis of the medical charts of pregnant women who had participated in a prospective study in Tennessee.
The study involved 7,932 singleton deliveries at six hospitals in Shelby County between 1997 and 1998.
A total of 7,503 of these women had some form of public, private, or military health insurance, and 429 (5%) had no insurance. This rate is slightly higher than the national average of 3%, he noted.
Uninsured women were more likely to be Hispanic than white, African American, or of other ethnic backgrounds. They were less likely to receive prenatal care, and those who did obtain prenatal care did so on average 1 month later in their pregnancies than insured women.
Uninsured mothers were more likely to have preterm delivery than were insured mothers (21% vs. 15%). Nevertheless, there were no differences between the two groups in perinatal or neonatal outcomes as measured by the rates of low birth weight, low Apgar scores, morbidity, and mortality.
The preterm infants of uninsured mothers had higher birth weights than the preterm infants of insured mothers.
It is possible that undiagnosed diabetes among these predominantly Hispanic mothers may account for this difference, Dr. Sewell said.
In the discussion period following his presentation, L. Wayne Hess, M.D., chairman of ob.gyn. at Lehigh Valley Hospital, Allentown, Pa., said that Dr. Sewell's study “showed just what you would expect.”
“Most physicians are dedicated and give the same quality of care regardless of the patient's ability to pay,” said Dr. Hess, who is also professor of ob.gyn. at Pennsylvania State University, Hershey.
Dr. Sewell noted that in 2003, 3% of pregnant women in the United States had no health insurance.
There are an estimated 120,000 births every year in this country to uninsured mothers, he commented.