The association of state percent uninsured and the likelihood of low birth weight: evidence from the 2016-2019 Pregnancy Risk Assessment Monitoring System.

OBJECTIVE: To evaluate the association of state-level lack of health insurance among women of reproductive age with variation in state low birth weight (LBW) rates. STUDY DESIGN: This cross-section study analyzes data from the 2016-2019 Pregnancy Risk Assessment Monitoring Survey for respondents with singleton, live births. METHODS: Respondents were divided into groups by state-level percent of uninsured women aged 19-44 years. Poisson regression was used to model the association between state percent uninsured and likelihood of LBW, controlling for individual sociodemographic and clinical risk factors. Sensitivity analyses were done for Medicaid and non-Hispanic Black subpopulations and alternative state characteristics, including Gini coefficients, total and public welfare expenditures, and state reproductive rights rankings. RESULTS: In adjusted multiple regression analyses, compared to respondents from states with <7% uninsured, respondents from states with 7% or more uninsured had an increased risk of LBW status (7-8.99% uninsured: adjusted incidence rate ratio [aIRR] 1.11, 95% confidence interval [CI] 1.04-1.18; 9-11.99% uninsured: aIRR 1.09, 95% CI 1.02-1.17; >11.99% uninsured: aIRR 1.15, 95% CI 1.08-1.22). However, there was no evident dose-response gradient. Sensitivity analyses produced virtually identical findings for subpopulations, and no other state characteristics were significant. CONCLUSION: States with the highest level of insurance coverage had a significantly lower LBW rate than other states. However, there was little evidence for greater odds of LBW with the highest levels of uninsured. Individual risk factors dominated LBW models, while state differences in income inequality, reproductive health policy, and per capita spending explained little of the variance in LBW.

Sexual partner testing for HIV to eliminate mother-to-child HIV transmission: a needs assessment in an urban hospital community clinic.

OBJECTIVE: To characterize pregnant patients' knowledge, attitudes and preferences regarding antenatal HIV testing for themselves and their sexual partners. STUDY DESIGN: Observational, mixed methods study of HIV-negative pregnant women from a university-based urban clinic. Participants completed an anonymous survey about HIV testing for themselves and their partners. Descriptive statistics, bivariable analyses, multivariable logistic regression and qualitative thematic analysis were utilized. RESULTS: One hundred and forty-two patients (mean age 28.6±5.5 years) participated. A majority (57.7%) were married or partnered, and 92.9% reported having at least one current sexual partner. Although a majority (62.8%) reported their partner had a prior HIV test, and 93.0% of these women were aware of test results, only 20.7% reported partner testing had occurred in the past 6 months. Women who had a prior HIV test, who were older or who were non-white were more likely to be aware of their partner's HIV status. A majority (66.9%) of women desired knowledge of their partner's current status and 76.0% believed their partners would like to know his HIV status; in addition, 74% were interested in receiving partner testing at the site of prenatal care. Qualitative analysis demonstrated that health concerns and believing HIV knowledge is important to the relationship were motivators for desiring partner testing. CONCLUSIONS: In this urban community, a majority of pregnant women do not know HIV test results of their sexual partner during the current pregnancy. Women desired to know their partner's HIV status and were receptive to partner testing at the site of prenatal care or other locations. Partner testing may be a critical step toward elimination of seroconversion during pregnancy and maternal-to-child HIV transmission.