Patients covered by Medicaid less likely to undergo 20-week ultrasound during pregnancy
Babies born to women with public health insurance are significantly less likely to be diagnosed with heart defects before birth, new data suggests.
Research published in the journal Prenatal Diagnosis highlights the impact of healthcare disparities among expectant mothers with Medicaid, revealing that those using public insurance may be less likely to undergo all recommended prenatal imaging exams. Most notably, Medicaid carriers more often forego their 20-week ultrasound—an important exam that analyzes all of a baby’s major organs.
“All pregnant people must know that this test should not be missed,” lead author Joyce Woo, MD, a pediatric cardiologist and assistant professor of pediatrics and medical social sciences at the Northwestern University Feinberg School of Medicine, said in a news release. “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.”
As Woo points out, Medicaid covers the 20-week anatomical scan. But this latest research suggests that over 13% of patients covered by Medicaid do not complete the exam. In the absence of this data, serious congenital heart defects could go undetected until after birth, posing substantial risk to an infant’s health.
“If CHD is suspected or there are risk factors for a fetal cardiac defect (e.g., genetic abnormality), a fetal echocardiogram is recommended," the team explained. "Sensitivity for detecting CHD on fetal echocardiogram approaches 90%; if CHD is identified, consultation with a pediatric cardiologist is necessary for counseling regarding pregnancy, perinatal, and lifelong care and outcomes.”
The study included 496 cases of infants that underwent corrective surgery for a congenital heart defect between 2019 and 2020. A little less than half were publicly insured at the time.
Of those included in the analysis, 61.5% had a prenatal diagnosis. Those who were covered by Medicaid were found to be 12.6% less likely to receive an appropriate diagnosis prior to giving birth. The team suggested that, for many of the women, this is likely attributable to the lack of a 20-week anatomical ultrasound.
“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,” Woo said.
The drivers of this disparity are multifaceted, especially considering that the exam is fully covered under Medicaid. The group indicated that women may forego the anatomy scan due to anxiety over the exam, or having had a prior genetic test that ruled out other anomalies, which could give the impression that additional tests are not needed. Future research should focus on improving obstetric counseling to give patients greater awareness of the importance of the anatomy scan, the team suggested.
Learn more about the study's findings here.
In addition to her background in journalism, Hannah also has patient-facing experience in clinical settings, having spent more than 12 years working as a registered rad tech. She joined Innovate Healthcare in 2021 and has since put her unique expertise to use in her editorial role with Health Imaging.