# Adverse Newborn Outcomes by Insurance Status Among Patients with Severe Maternal Morbidity in Maryland: 2020–2023

## TL;DR

This study finds that Medicaid-insured patients with severe maternal complications are more likely to have adverse newborn outcomes compared to those with commercial insurance.

## Contribution

The study provides new evidence on disparities in newborn outcomes by insurance type among patients with severe maternal morbidity.

## Key findings

- Medicaid patients had 2.2 to 2.6 times higher odds of adverse newborn outcomes after adjusting for socio-demographic and medical factors.
- Comorbidities and most primary SMM causes increased the odds of adverse newborn outcomes.
- Medicaid patients were younger, more racially diverse, and had later prenatal care initiation compared to commercially insured patients.

## Abstract

Background: Adverse newborn outcomes in patients with severe maternal morbidity (SMM) are understudied, and this study examines their association with insurance type (Medicaid vs. commercial) in patients who experienced SMM. The aim of this study is to examine disparities in preterm birth, low birthweight, and neonatal intensive care (NICU) admission among Medicaid vs. commercially insured patients with severe maternal morbidity in Maryland. Methods: This cross-sectional study analyzed data from 588 SMM patients enrolled in Maryland’s Severe Maternal Morbidity (SMM) Surveillance Program (August 2020–December 2023). We utilized unadjusted and multivariable logistic regression models to evaluate the relationship between primary insurance type and the outcomes of interest: preterm birth (<37 weeks), low birthweight (<2500 g), and neonatal intensive care unit (NICU) admissions. Results: Of 588 patients with SMM, 45.1% had Medicaid. These patients were younger, more often non-Hispanic Black or Hispanic, had higher parity and comorbidity scores, and initiated prenatal care later compared with commercially insured patients. Medicaid patients had 2.2 to 2.6 times higher odds of adverse newborn outcomes after adjusting for other socio-demographic and medical factors. Patients’ comorbidities significantly increased the odds of adverse newborn outcomes, as did all other primary SMM causes other than obstetric hemorrhage. Conclusions: Adverse newborn outcomes were more prevalent among Medicaid than commercially insured patients who experienced SMM. Differences in maternal health status and primary SMM cause partly explain the observed differences in newborn outcomes. Our findings emphasize the need for comprehensive prenatal care and improved healthcare access for women with high-risk pregnancies.