Maternal Health

Women who have had a recent live birth.

Women who reported that they had a postpartum checkup.

Women who reported that they had or did not have a postpartum checkup.

Prevalence (crude).

Up to 12 weeks after the most recent live birth.

The American College of Obstetricians and Gynecologists recommends that all women attend an initial postpartum visit no later than 3 weeks after birth with a comprehensive postpartum visit within 12 weeks of birth.¹ The postpartum check-up is an opportunity for providers to assess a woman’s physical, social, and psychological well-being following delivery. The postpartum visit allows providers to counsel patients with chronic medical conditions, such as obesity, hypertensive disorders, diabetes, substance use disorders, and mental health disorders, about the importance of timely follow-up with providers.¹ Though 88.1% of PRAMS respondents in 2020 reported attending a postpartum visit,² attendance at the postpartum visit is lower among some sub-populations of women that are at higher risk for poor pregnancy outcomes.^3,4

Some respondents may consider a health care visit for some other reason (e.g., to monitor a chronic health condition or to treat a specific illness or injury) as a postpartum checkup. The time period above reflects the question to be asked beginning with 2023 births (PRAMS Phase 9). Data from PRAMS Phase 8 (2016–2022 births) results from the same question but with a slightly different definition of postpartum checkup provided in a sentence following the question. Phase 8 describes a postpartum checkup as a regular checkup that a woman has about 4 to 6 weeks after she gives birth as compared to Phase 9 which describes it as a regular checkup one has up to 12 weeks after giving birth.

Pregnancy Risk Assessment Monitoring System (PRAMS).

Healthy People 2030 objective: MICH-04. Reduce maternal deaths.

None.

ACOG Committee Opinion No. 736: Optimizing postpartum care. Obstet Gynecol. 2018;131(5):e140–e50. doi: 10.1097/AOG.0000000000002633

Centers for Disease Control and Prevention, 2022. Prevalence of Selected Maternal and Child Health Indicators for All Pregnancy Risk Assessment Monitoring System (PRAMS) Sites, 2016–2020. https://www.cdc.gov/prams/prams-data/mch-indicators/states/pdf/2020/all-sites-prams-mch-indicators-508.pdf

Danilack VA, Brousseau EC, Paulo BA, Matteson KA, Clark MA. Characteristics of women without a postpartum checkup among PRAMS participants, 2009–2011. Matern Child Health J. 2019;23(7):903–9. doi: 10.1007/s10995-018-02716-x

Bennett WL, Chang HY, Levine DM, et al. Utilization of primary and obstetric care after medically complicated pregnancies: an analysis of medical claims data. J Gen Intern Med. 2014;29(4):636-45. doi: 10.1007/s11606-013-2744-2

Women who have had a recent live birth.

Number of women who reported they used alcohol during their most recent pregnancy resulting in a live birth.

Number of women who reported that they did or did not use alcohol during their most recent pregnancy resulting in a live birth.

Prevalence (crude).

During the pregnancy resulting in the most recent live birth.

Approximately 1 in 7 pregnant adults drank alcohol in the past 30 days.¹ Alcohol use during pregnancy is associated with many adverse pregnancy and birth outcomes, such as fetal alcohol spectrum disorders, miscarriage, stillbirth, preterm delivery, and sudden infant death syndrome.² Clinical intervention, such as routine alcohol use screening during prenatal care³ and patient counseling⁴ may reduce use and subsequently prevent adverse outcomes.^3,4

This indicator results from a new question in a new phase of the PRAMS survey, Phase 9. Phase 9 PRAMS data will not be available until 2024 (Phase 9 will begin with 2023 births).

Pregnancy Risk Assessment Monitoring System (PRAMS).

Healthy People 2030 Objective MICH-09: Increase abstinence from alcohol among pregnant women.

Alcohol.

Gosdin LK, Deputy NP, Kim SY, Dang EP, Denny CH. Alcohol consumption and binge drinking during pregnancy among adults aged 18–49 years — United States, 2018–2020. MMWR Morb Mortal Wkly Rep. 2022;71(1):10–13. doi:10.15585/mmwr.mm7101a2

Bailey BA, Sokol RJ. Prenatal alcohol exposure and miscarriage, stillbirth, preterm delivery, and sudden infant death syndrome. Alcohol Res Health. 2011;34(1):86–91.

American College of Obstetricians and Gynecologists. Committee opinion no. 633: alcohol abuse and other substance use disorders ethical issues in obstetric and gynecologic practice. Obstet Gynecol. 2015;125(6):1529–1537. doi:10.1097/01.AOG.0000466371.86393.9b

US Preventive Services Task Force. Screening and behavioral counseling interventions to reduce unhealthy alcohol use in adolescents and adults: US Preventive Services Task Force recommendation statement. JAMA. 2018;320(18):1899–1909. doi:10.1001/jama.2018.16789

Women who have had a recent live birth.

Number of women who reported that they had 4 or more alcoholic drinks in a 2-hour time span during their most recent pregnancy resulting in a live birth.

Number of women who reported they used alcohol during their most recent pregnancy resulting in a live birth.

Prevalence (crude).

During the pregnancy resulting in the most recent live birth.

In findings from 2018-2020, forty percent of pregnant adults who reported alcohol use in the past 30 days also reported binge drinking.¹ Prevalence of binge drinking during pregnancy increased from 2011 to 2020.² Alcohol use during pregnancy is associated with many adverse pregnancy and birth outcomes^3, and binge drinking may be particularly harmful to fetal development compared to other drinking patterns.4 Routine alcohol use screening and behavioral counseling may reduce use and subsequently prevent adverse outcomes.^5,6

This indicator results from a new question in a new phase of the PRAMS survey, Phase 9. Phase 9 PRAMS data will not be available until 2024 (Phase 9 will begin with 2023 births).

Pregnancy Risk Assessment Monitoring System (PRAMS).

Healthy People 2030 objective: MICH-09. Increase abstinence from alcohol among pregnant women.

Alcohol.

Gosdin LK, Deputy NP, Kim SY, Dang EP, Denny CH. Alcohol consumption and binge drinking during pregnancy among adults aged 18–49 years — United States, 2018–2020. MMWR Morb Mortal Wkly Rep. 2022;71(1):10–13. doi:10.15585/mmwr.mm7101a2

Howard JT, Perrotte JK, Flores K, et al. Trends in binge drinking and heavy alcohol consumption among pregnant women in the US, 2011 to 2020. JAMA Netw Open. 2022;5(8):e2224846. doi:10.1001/jamanetworkopen.2022.24846

Bailey BA, Sokol RJ. Prenatal alcohol exposure and miscarriage, stillbirth, preterm delivery, and sudden infant death syndrome. Alcohol Res Health. 2011;34(1):86–91.

Maier SE, West JR. Drinking patterns and alcohol-related birth defects. Alcohol Res Health. 2001;25(3):168–174.

American College of Obstetricians and Gynecologists. Committee opinion no. 633: alcohol abuse and other substance use disorders ethical issues in obstetric and gynecologic practice. Obstet Gynecol. 2015;125(6):1529–1537. doi:10.1097/01.AOG.0000466371.86393.9b

US Preventive Services Task Force. Screening and behavioral counseling interventions to reduce unhealthy alcohol use in adolescents and adults: US Preventive Services Task Force recommendation statement. JAMA. 2018;320(18):1899–1909. doi:10.1001/jama.2018.16789

Women who have had a recent live birth.

Women who reported that a healthcare provider told them during their most recent pregnancy that they had high blood pressure (that started during their most recent pregnancy), pre-eclampsia, or eclampsia. See notes below.

Women who reported they did or did not have a health care provider who told them during their most recent pregnancy that they had high blood pressure (that started during their most recent pregnancy), pre-eclampsia, or eclampsia.

Prevalence (crude).

During the pregnancy resulting in the most recent live birth.

Hypertensive disorders of pregnancy are a common pregnancy complication in the United States¹ and are strongly associated with severe maternal complications² such as stroke and pregnancy-related death.³ Hypertensive disorders of pregnancy are also an important risk factor for future cardiovascular disease and cardiovascular mortality.^4,5 Counseling related to future pregnancies and cardiovascular disease risk factor reduction beyond the postpartum period,⁶ including lifestyle interventions,⁷ can reduce cardiovascular risk.⁶

The numerator above reflects the question to be asked beginning with 2023 births (PRAMS Phase 9). Data from PRAMS Phase 8 (2016-2022 births) results from a slightly different question. The numerator for Phase 8 data is “Number of respondents who reported that during their most recent pregnancy they had high blood pressure (that started during their most recent pregnancy), pre-eclampsia, or eclampsia”.

Pregnancy Risk Assessment Monitoring System (PRAMS).

Healthy People 2030 objective: MICH-06. Reduce maternal illness and complications due to pregnancy (complications during hospitalized labor and delivery).

Cardiovascular Disease.

Ford ND, Cox S, Ko JY, et al. Hypertensive disorders in pregnancy and mortality at delivery hospitalization — United States, 2017–2019. MMWR Morb Mortal Wkly Rep. 2022;71(17):585–591. doi:10.15585/MMWR.MM7117A1

Hitti J, Sienas L, Walker S, Benedetti TJ, Easterling T. Contribution of hypertension to severe maternal morbidity. Am J Obstet Gynecol. 2018;219(4):405.E1–405.E7. doi:10.1016/J.AJOG.2018.07.002

Trost SL, Beauregard J, Njie F, et al. Pregnancy-Related Deaths: Data from Maternal Mortality Review Committees in 36 US States, 2017-2019. Centers for Disease Control and Prevention, US Department of Health and Human Services; 2022. Accessed April 3, 2023. https://www.cdc.gov/reproductivehealth/maternal-mortality/docs/pdf/Pregnancy-Related-Deaths-Data-MMRCs-2017-2019-H.pdf

Parikh NI, Gonzalez JM, Anderson CA, et al. Adverse pregnancy outcomes and cardiovascular disease risk: unique opportunities for cardiovascular disease prevention in women: a scientific statement from the American Heart Association. Circulation. 2021;143(18):e902–e916. doi:10.1161/CIR.0000000000000961

Arnott C, Nelson M, Ramirez MA, et al. Maternal cardiovascular risk after hypertensive disorder of pregnancy. Heart. 2020;106(24). doi:10.1136/HEARTJNL-2020-316541

American College of Obstetricians and Gynecologists’ Committee on Practice Bulletins–Obstetrics in collaboration with the Presidential Task Force on Pregnancy and Heart Disease. ACOG practice bulletin no. 212: pregnancy and heart disease. Obstet Gynecol. 2019;133(5):e320–e356. doi:10.1097/AOG.0000000000003243

Berks D, Hoedjes M, Raat H, Duvekot J, Steegers E, Habbema J. Risk of cardiovascular disease after pre-eclampsia and the effect of lifestyle interventions: a literature-based study. BJOG. 2013;120(8):924–931. doi:10.1111/1471-0528.12191

Women who have had a recent live birth.

Women who reported that a healthcare provider told them during their most recent pregnancy that they had high blood pressure (that started during their most recent pregnancy), pre-eclampsia, or eclampsia. See notes below.

Women who reported that did or did not have a healthcare provider who told them during their most recent pregnancy that they had high blood pressure (that started during their most recent pregnancy), pre-eclampsia, or eclampsia.

Prevalence (crude).

During the pregnancy resulting in the most recent live birth.

Hypertensive disorders of pregnancy are a common pregnancy complication in the United States¹ and are strongly associated with severe maternal complications² such as stroke and pregnancy-related death.³ Hypertensive disorders of pregnancy are also an important risk factor for future cardiovascular disease and cardiovascular mortality.^4,5 Counseling related to future pregnancies and cardiovascular disease risk factor reduction beyond the postpartum period,⁶ including lifestyle interventions,⁷ can reduce cardiovascular risk.⁶

The numerator above reflects the question to be asked beginning with 2023 births (PRAMS Phase 9). Data from PRAMS Phase 8 (2016-2022 births) results from a slightly different question. The numerator for Phase 8 data is “Number of respondents who reported that during their most recent pregnancy they had high blood pressure (that started during their most recent pregnancy), pre-eclampsia, or eclampsia”.

Pregnancy Risk Assessment Monitoring System (PRAMS).

Healthy People 2030 objective: MICH-06. Reduce maternal illness and complications due to pregnancy (complications during hospitalized labor and delivery).

Cardiovascular Disease.

Ford ND, Cox S, Ko JY, et al. Hypertensive disorders in pregnancy and mortality at delivery hospitalization — United States, 2017–2019. MMWR Morb Mortal Wkly Rep. 2022;71(17):585–591. doi:10.15585/MMWR.MM7117A1

Hitti J, Sienas L, Walker S, Benedetti TJ, Easterling T. Contribution of hypertension to severe maternal morbidity. Am J Obstet Gynecol. 2018;219(4):405.E1–405.E7. doi:10.1016/J.AJOG.2018.07.002

Trost SL, Beauregard J, Njie F, et al. Pregnancy-Related Deaths: Data from Maternal Mortality Review Committees in 36 US States, 2017-2019. Centers for Disease Control and Prevention, US Department of Health and Human Services; 2022. Accessed April 3, 2023. https://www.cdc.gov/reproductivehealth/maternal-mortality/docs/pdf/Pregnancy-Related-Deaths-Data-MMRCs-2017-2019-H.pdf

Parikh NI, Gonzalez JM, Anderson CA, et al. Adverse pregnancy outcomes and cardiovascular disease risk: unique opportunities for cardiovascular disease prevention in women: a scientific statement from the American Heart Association. Circulation. 2021;143(18):e902–e916. doi:10.1161/CIR.0000000000000961

Arnott C, Nelson M, Ramirez MA, et al. Maternal cardiovascular risk after hypertensive disorder of pregnancy. Heart. 2020;106(24). doi:10.1136/HEARTJNL-2020-316541

American College of Obstetricians and Gynecologists’ Committee on Practice Bulletins–Obstetrics in collaboration with the Presidential Task Force on Pregnancy and Heart Disease. ACOG practice bulletin no. 212: pregnancy and heart disease. Obstet Gynecol. 2019;133(5):e320–e356. doi:10.1097/AOG.0000000000003243

Berks D, Hoedjes M, Raat H, Duvekot J, Steegers E, Habbema J. Risk of cardiovascular disease after pre-eclampsia and the effect of lifestyle interventions: a literature-based study. BJOG. 2013;120(8):924–931. doi:10.1111/1471-0528.12191

Women who have had a recent live birth.

Number of women who reported that they always or often felt down, depressed, or hopeless, or had little interest or little pleasure in doing things since delivery of their most recent live birth.

Number of women who reported that they always, often, sometimes, rarely, or never felt down, depressed, or hopeless and reported that they always, often, sometimes, rarely or never had little interest or little pleasure in doing things since delivery of their most recent live birth.

Prevalence (crude).

Since the most recent live birth.

Experiencing symptoms of depression in the postpartum period is common^1-3 and symptoms often reoccur. Over half of women with depression in the postpartum period had a diagnosis either during or preceding pregnancy.³ Postpartum depression has negative effects on maternal health, relationships, and behaviors; infant cognitive and language development and quality of sleep; and on mother-child interactions, including bonding and breastfeeding.⁴

This indicator represents self-reported depressive symptoms only and is not equivalent to a diagnosis of depression. Further, it cannot be used to distinguish reoccurring symptoms or new symptoms, only those at time of survey. Various similar tools assessing self-reported depressive symptoms including feelings of being down, depressed, sad, or hopeless, have been recommended for depression case-finding. Sensitivity measures for these tools is generally high with moderate to high specificity measures.^{5, 6}

Pregnancy Risk Assessment Monitoring System (PRAMS).

None.

Mental Health

Bauman BL, Ko JY, Cox S, et al. Vital Signs: postpartum depressive symptoms and provider discussions about perinatal depression — United States, 2018. MMWR Morb Mortal Wkly Rep. 2020;69(19):575–581. doi:10.15585/mmwr.mm6919a2

Le Strat Y, Dubertret C, Le Foll B. Prevalence and correlates of major depressive episode in pregnant and postpartum women in the United States. J Affect Disord. 2011;135(1–3):128–138. doi:10.1016/j.jad.2011.07.004

Dietz PM, Williams SB, Callaghan WM, Bachman DJ, Whitlock EP, Hornbrook MC. Clinically identified maternal depression before, during, and after pregnancies ending in live births. Am J Psychiatry. 2007;164(10):1515–1520 doi:10.1176/appi.ajp.2007.06111893

Slomian J, Honvo G, Emonts P, Reginster J, Bruyère O. Consequences of maternal postpartum depression: a systematic review of maternal and infant outcomes. Womens Health (Lond). 2019;15. doi:10.1177/1745506519844044

Manea L, Gilbody S, Hewitt C, et al. Identifying depression with the PHQ-2: a diagnostic meta-analysis. J Affect Disord. 2016;203:382–395. doi:10.1016/j.jad.2016.06.003

Kroenke K, Spitzer RL, Williams JBW. The Patient Health Questionnaire-2: validity of a two-item depression screener. Med Care. 2003;41(11):1284–1292. doi:10.1097/01.MLR.0000093487.78664.3C

Women who have had a recent live birth.

Number of women who reported that, since their most recent live birth, a healthcare provider assessed whether they were feeling down, depressed, anxious, or irritable.

Number of women who reported that, since their most recent live birth, a healthcare provider had or had not assessed whether they were feeling down, depressed, anxious, or irritable.

Prevalence (crude) from a 2-year cycle.

Since the most recent live birth.

Perinatal mental health conditions are often underdiagnosed and under-or untreated^.1 Detection or screening is often the first step in the care pathway for mental health conditions,¹ including depression.^{2, 3} Multiple professional and clinical organizations recommend screening for perinatal depression, including the American College of Obstetricians and Gynecologists (ACOG),⁴ the American Academy of Pediatrics,⁵ and the United States Preventive Services Task Force.⁶ The Women’s Preventive Services Initiative, a federally supported collaborative program led by ACOG, recommends screening for anxiety in adolescent and adult women, including those who are pregnant or postpartum.

Indicates whether a health care provider inquired about depression and anxiety during postpartum visits but does not indicate whether recommended screening and referrals were performed or of the content of any care provided outside of the health care setting. Self-report data on sensitive topics are subject to social desirability bias; challenges with recalling past experiences also may introduce bias. This indicator results from a new question in a new phase of the PRAMS survey, Phase 9. Phase 9 PRAMS data will not be available until 2024 (Phase 9 will begin with 2023 births).

Pregnancy Risk Assessment Monitoring System (PRAMS).

Healthy People 2030 Objective MICH-D01: Increase the proportion of women who get screened for postpartum depression

Mental Health

The American College of Obstetricians and Gynecologists. Perinatal Mental Health Tool Kit. The American College of Obstetricians and Gynecologists. Accessed April 3, 2023. https://www.acog.org/programs/perinatal-mental-health

Byatt N, Xu W, Levin LL, Moore Simas TA. Perinatal depression care pathway for obstetric settings. Int Rev Psychiatry. 2019;31(3):210–228. doi:10.1080/09540261.2018.1534725

Bauman BL, Ko JY, Cox S, et al. Vital Signs: postpartum depressive symptoms and provider discussions about perinatal depression — United States, 2018. MMWR Morb Mortal Wkly Rep. 2020;69(19):575–581. doi:10.15585/mmwr.mm6919a2

American College of Obstetricians and Gynecologists’ Committee on Obstetric Practice. ACOG committee opinion no. 757: screening for perinatal depression. Obstet Gynecol. 2018;132(5):e208–e212. doi:10.1097/AOG.0000000000002927

Earls MF, Yogman MW, Mattson G, et al. Incorporating recognition and management of perinatal depression into pediatric practice. Am Acad Pediatr. 2019;143(1). doi:10.1542/peds.2018-3259

Siu AL, US Preventive Services Task Force. Screening for depression in adults: US Preventive Services Task Force recommendation statement. JAMA. 2016;315(4):380–387. doi:10.1001/jama.2015.18392

Women who have had a recent live birth.

Women who reported that they had their teeth cleaned by a dentist or dental hygienist in the 12 months before their most recent pregnancy.

Women who did not have a health care visit in the 12 months before pregnancy, or who had a health care visit in the 12 months before their most recent pregnancy and reported that they did or did not have their teeth cleaned by a dentist or dental hygienist.

Annual prevalence (crude).

During the 12 months before the pregnancy resulting in the most recent live birth.

Physiologic and behavioral changes during pregnancy may impact women’s oral health.¹ Routine dental care before, during and after pregnancy is essential for women to receive oral health education and preventive and treatment services, and thereby promote healthy pregnancy, and oral and overall health of mothers and children.^1,2 The American Academy of Periodontology recommends periodontal evaluation and treatment and good oral hygiene for women before and during pregnancy.³ In 2020, among women with a recent live birth in 42 PRAMS participating jurisdictions, the overall prevalence of having a teeth cleaning in the 12 months before pregnancy was 41.9%.⁴ Lower dental use before and during pregnancy was reported among racial and ethnic minority women and women without dental insurance.^5,6 Improving dental use for women around pregnancy requires interprofessional collaboration among obstetric, oral health and other health professionals.⁷

None

Pregnancy Risk Assessment Monitoring System (PRAMS).

Healthy People 2030 Objective: Increase proportion of children, adolescents, and adults who use the oral health care system – OH-08.

Oral Health

American College of Obstetricians and Gynecologists, Committee on Health Care for Underserved Women. Committee Opinion No. 569: oral health care during pregnancy and through the lifespan (Reconfirmed 2017). Obstet Gynecol. 2013;122(2):417-22.

Johnson K, Posner SF, Biermann J, et al. Recommendations to improve preconception health and health care — United States. A report of the CDC/ATSDR Preconception Care Work Group and the Select Panel on Preconception Care. MMWR Recomm Rep. 2006;55(Rr-6):1-23.

American Academy of Periodontology. American Academy of Periodontology statement regarding periodontal management of the pregnant patient. J Periodontol. 2004;75(3):495.

Centers for Disease Control and Prevention. Chronic Disease Indicators (CDI) Data. Centers for Disease Control and Prevention; 2022. https://nccd.cdc.gov/cdi

Robison V, Bauman B, D’Angelo DV, Espinoza L, Thornton-Evans G, Lin M. The impact of dental insurance and medical insurance on dental care utilization during pregnancy. Maternal and Child Health Journal. 2021;25(5):832-40.

Robbins CL, Zapata LB, Farr SL, et al. Core state preconception health indicators — pregnancy risk assessment monitoring system and behavioral risk factor surveillance system, 2009. MMWR Surveill Summ. 2014;63(3):1-62.

American Public Health Association. Policy Statement: Improving Access to Dental Care for Pregnant Women through Education, Integration of Health Services, Insurance Coverage, an Appropriate Dental Workforce, and Research 2020. American Public Health Association; 2020. https://www.apha.org/policies-and-advocacy/public-health-policy-statements/policy-database/2021/01/12/improving-access-to-dental-care-for-pregnant-women

Women who have had a recent live birth.

Respondents who reported that they had health insurance coverage during the month before they became pregnant.

Respondents who reported that they did or did not have health insurance coverage during the month before they became pregnant.

Prevalence (crude).

One month before the pregnancy resulting in the most recent live birth.

In 2021, approximately 11.3% of U.S. women aged 18–64 did not have health insurance.¹ Lack of health insurance has been associated with decreased access to quality health services before, during, and after pregnancy.² Young women, racial and ethnic minority women, women with low income, and women who live in rural areas are more likely to experience gaps in their health insurance coverage during pregnancy and post-partum.^2–5 Continuous access to health insurance and care is especially important for recently pregnant women with chronic medical conditions, such as diabetes or hypertension.⁶ Removing barriers to obtaining health insurance for women who lack coverage could improve timeliness of prenatal care and the health of women and their infants.

Because the income threshold for pregnancy-eligibility Medicaid is greater than other eligibility based on income, many persons who are uninsured before pregnancy, may be covered by Medicaid during pregnancy. Since individual persons might move in and out of health insurance, this indicator might underestimate the prevalence of a lack of health insurance.

Pregnancy Risk Assessment Monitoring System (PRAMS).

Health People objective: AHS-01. Increase the proportion of people with health insurance

Social Determinants of Health.

Cohen RA, Cha AE, Terlizzi EP, Martinez ME. Health Insurance Coverage: Early Release of Estimates from the National Health Interview Survey, 2021. National Center for Health Statistics; 2022. https://www.cdc.gov/nchs/data/nhis/earlyrelease/insur202205.pdf

Daw JR, Kolenic GE, Dalton VK, et al. Racial and ethnic disparities in perinatal insurance coverage. Obstet Gynecol. 2020;135(4):917-924. doi: 10.1097/AOG.0000000000003728

Interrante JD, Admon LK, Carroll C, Henning-Smith C, Chastain P, Kozhimannil KB. Association of health insurance, geography, and race and ethnicity with disparities in receipt of recommended postpartum care in the US. JAMA Health Forum. 2022;3(10):e223292. doi: 10.1001/jamahealthforum.2022.3292

Admon LK, Daw JR, Winkelman TNA, et al. Insurance coverage and perinatal health care use among low-income women in the US, 2015-2017. JAMA Netw Open. 2021; 4(1):e2034549. doi: 10.1001/jamanetworkopen.2020.34549

D’Angelo DV, Williams L, Harrison L, Ahluwalia IB. Health status and health insurance coverage of women with live-born infants: an opportunity for preventive services after pregnancy. Matern Child Health J. 2012;16 Suppl 2(0 2):222-30. doi: 10.1007/s10995-012-1172-y

American College of Obstetricians and Gynecologists, Society for Maternal-Fetal Medicine. Obstetric care consensus No. 8: interpregnancy care. Obstet Gynecol. 2019;133(1):e51-e72.

Women who have had a recent live birth.

Women who reported that they had health insurance coverage now (at the time the survey was completed).

Women who reported that they did or did not have health insurance coverage now.

Prevalence (crude).

Two to six months after the most recent live birth

In 2021, approximately 11.3% of U.S. women aged 18–64 did not have health insurance.¹ Lack of health insurance has been associated with decreased access to quality health services before, during and after pregnancy.² Young women, racial and ethnic minority women, women with low income, and women who live in rural areas are more likely to experience gaps in their health insurance coverage during pregnancy and post-partum.^2–5 Continuous access to health insurance and care is especially important for recently pregnant women, or those who have recently given birth, with chronic medical conditions, such as diabetes or hypertension.⁶ Removing barriers to health insurance in the year after pregnancy could improve the health of women and their infants.

Currently, states are required to extend Medicaid coverage for 60 days after the end of pregnancy. Strategies for states to extend Medicaid coverage beyond 60 days in the postpartum period include state plan amendments and 1115 demonstration waivers. . Since individual persons might move in and out of health insurance, this indicator might underestimate the prevalence of a lack of health insurance.

Pregnancy Risk Assessment Monitoring System (PRAMS).

Healthy People 2030 objective: AHS-01. Increase the proportion of people with health insurance

Social Determinants of Health.

Cohen RA, Cha AE, Terlizzi EP, Martinez ME. Health Insurance Coverage: Early Release of Estimates from the National Health Interview Survey, 2021. National Center for Health Statistics; 2022. https://www.cdc.gov/nchs/data/nhis/earlyrelease/insur202205.pdf

Daw JR, Kolenic GE, Dalton VK, et al. Racial and ethnic disparities in perinatal insurance coverage. Obstet Gynecol. 2020;135(4):917-924. doi: 10.1097/AOG.0000000000003728

Interrante JD, Admon LK, Carroll C, Henning-Smith C, Chastain P, Kozhimannil KB. Association of health insurance, geography, and race and ethnicity with disparities in receipt of recommended postpartum care in the US. JAMA Health Forum. 2022;3(10):e223292. doi: 10.1001/jamahealthforum.2022.3292

Admon LK, Daw JR, Winkelman TNA, et al. Insurance coverage and perinatal health care use among low-income women in the US, 2015-2017. JAMA Netw Open. 2021; 4(1):e2034549. doi: 10.1001/jamanetworkopen.2020.34549

D’Angelo DV, Williams L, Harrison L, Ahluwalia IB. Health status and health insurance coverage of women with live-born infants: an opportunity for preventive services after pregnancy. Matern Child Health J. 2012;16 Suppl 2(0 2):222-30. doi: 10.1007/s10995-012-1172-y

American College of Obstetricians and Gynecologists, Society for Maternal-Fetal Medicine. Obstetric care consensus No. 8: interpregnancy care. Obstet Gynecol. 2019;133(1):e51-e72.

Women who have had a recent live birth.

Number of women who smoked cigarettes in the last 3 months of their pregnancy. All response options other than "I didn’t smoke then" to a question about number of cigarettes smoked on an average day indicate having smoked.

Number of women who did or did not smoke cigarettes in the last 3 months of their pregnancy.

Prevalence (crude).

During the last three months of the pregnancy resulting in the most recent live birth.

Women who smoke cigarettes during pregnancy are at increased risk of pregnancy complications, including ectopic pregnancy and miscarriage, as well as poor infant outcomes, including restricted fetal growth, cleft lip and/or cleft palate, preterm delivery, and sudden infant death syndrome.¹ Pregnant smokers should be offered effective smoking cessation interventions or referred to cessation services.² In addition to reducing adverse pregnancy outcomes, women who quit smoking during pregnancy may continue to abstain from smoking postpartum, a long-term health benefit for the mother and child.¹

Pregnant women might underreport smoking and overreport quitting smoking. A validation study comparing self-reports with serum cotinine found that 23% of pregnant smokers did not disclose their smoking.³

Pregnancy Risk Assessment Monitoring System (PRAMS).

Healthy People 2030 objective: MICH-10. Increase abstinence from cigarette smoking among pregnant women.

Tobacco.

Office of the Surgeon General. The Health Consequences of Smoking—50 Years of Progress: A Report of the Surgeon General. US Dept of Health and Human Services; 2014. https://www.ncbi.nlm.nih.gov/books/NBK179276/pdf/Bookshelf_NBK179276.pdfhttps://www.ncbi.nlm.nih.gov/books/NBK179276/pdf/Bookshelf_NBK179276.pdf

American College of Obstetricians and Gynecologists’ Committee on Obstetric Practice in collaboration with committee member Amy M. Valent and the American Academy of Family Physicians’ liaison member Beth Choby. Tobacco and nicotine cessation during pregnancy: ACOG committee opinion, number 807. Obstet Gynecol. 2020;135(5):e221–e229. doi:10.1097/AOG.0000000000003822

Dietz PM, Homa D, England LJ, et al. Estimates of nondisclosure of cigarette smoking among pregnant and nonpregnant women of reproductive age in the United States. Am J Epidemiol. 2011;173(3):355–359. doi:10.1093/aje/kwq381