Medicaid Patients Less Likely to Receive Prenatal 20-Week Ultrasound

Patients insured by Medicaid are less likely to get prenatal diagnosis of heart defects than those with private insurance, and this disparity can be partly attributed to lower rates of 20-week ultrasound in pregnant people with public insurance, according to a study led by Ann & Robert H. Lurie Children’s Hospital of Chicago in collaboration with Advocate Christ Children’s Hospital. The study was published in the journal Prenatal Diagnosis.

“The 20-week ultrasound is hugely important in detecting birth defects because it involves assessment of the baby’s major organs. All pregnant people must know that this test should not be missed,” said lead author Joyce Woo, MD, MS, pediatric cardiologist at Lurie Children’s and Assistant Professor of Pediatrics and Medical Social Sciences at Northwestern University Feinberg School of Medicine. “It is a routine part of prenatal care that is covered by Medicaid, but patients can still experience barriers to getting this test, such as inability to take time off work. Our study suggests that one way to increase rates of prenatal diagnosis of heart defects and mitigate insurance-related disparities, is to increase utilization of 20-week ultrasound.”

Dr Woo’s research program focuses on ways to improve prenatal diagnosis, so that children with congenital heart defects (CHD) can receive the best care possible, starting from the moment they are born. In a previous study, her team found that prenatal diagnosis of CHD – the most common birth defects in the United States – is associated with improved outcomes. In another study, they discovered that the most common socioeconomic barriers to prenatal diagnosis were difficulty with appointment scheduling, distance to care or lack of transportation access, challenges with getting time off work to attend appointments, and lack of childcare.

For the current study, Dr Woo and colleagues analyzed electronic health records of pregnant individuals whose infants received surgery to correct a CHD between 2019-2020 in the Chicago metropolitan area, the third-largest metropolitan area in the United States. They confirmed previously published findings that public insurance is associated with lower likelihood of prenatal CHD diagnosis. They also found that this disparity is driven by whether the patient receives the 20-week ultrasound (also called second trimester ultrasound or anatomy scan).

“Understanding the reasons behind insurance-related disparities in getting prenatal diagnosis – such as getting the second-trimester ultrasound – allows for the development of policies and programs that could lessen these disparities,” said Dr Woo. “Prenatal diagnosis is critical to the health of babies with congenital heart defects. We know from our earlier research that prenatal diagnosis means timelier surgery, which is often better for the baby’s neurodevelopmental and physical outcomes.”