{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,22]],"date-time":"2026-04-22T19:41:06Z","timestamp":1776886866586,"version":"3.51.2"},"reference-count":18,"publisher":"Wiley","issue":"2","license":[{"start":{"date-parts":[[2024,3,6]],"date-time":"2024-03-06T00:00:00Z","timestamp":1709683200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["obgyn.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Intl J Gynecology &amp; Obste"],"published-print":{"date-parts":[[2024,5]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Introduction<\/jats:title><jats:p>The Affordable Care Act (ACA) aims to broaden health care access and significantly impacts obstetric practices. Yet, its effect on maternal and neonatal outcomes among women with gestational diabetes across diverse demographics is underexplored.<\/jats:p><\/jats:sec><jats:sec><jats:title>Objective<\/jats:title><jats:p>This study examines the impact of the implementation of the ACA on maternal and neonatal health in Maryland with ACA implementation and Georgia without ACA implementation.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methodology<\/jats:title><jats:p>We used data from the Maryland State Inpatient Database and US Vital Statistics System to assess the ACA's influence on maternal and neonatal outcomes in Maryland, with Georgia serving as a nonexpansion control state. Outcomes compared include cesarean section (CS) rates, low Apgar scores, neonatal intensive care unit (NICU) admissions, and assisted ventilation 7\u2009h postdelivery. We adjusted for factors including women's age, race, insurance type, preexisting conditions, prior CS, prepregnancy obesity, weight gain during pregnancy, birth weight, labor events, and antenatal practices.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>The study included 52\u2009479 women: 55.8% from Georgia and 44.2% from Maryland. Post\u2010ACA, CS rates were 45.1% in Maryland versus 48.2% in Georgia (<jats:italic>P<\/jats:italic>\u2009=\u20090.000). Maryland demonstrated better outcomes, including lower rates of low Agar scores (odds ratio [OR], 0.74 [95% confidence interval (CI), 0.63\u20130.86]), assisted ventilation (OR, 0.79 [95% CI, 0.71\u20130.82]), and NICU admissions (OR, 0.76 [95% CI, 0.71\u20130.82]), but no significant change in CS rates (OR, 0.96 [95% CI, 0.92\u20131.01]).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>After ACA implementation, Maryland showed improved maternal and neonatal outcomes compared with Georgia, a nonexpansion state.<\/jats:p><\/jats:sec>","DOI":"10.1002\/ijgo.15439","type":"journal-article","created":{"date-parts":[[2024,3,6]],"date-time":"2024-03-06T11:43:48Z","timestamp":1709725428000},"page":"519-525","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":4,"title":["Impact of Medicaid expansion on pregnancy outcomes among women with gestational diabetes"],"prefix":"10.1002","volume":"165","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8530-3681","authenticated-orcid":false,"given":"Oluwasegun","family":"Akinyemi","sequence":"first","affiliation":[{"name":"Department of Surgery Outcomes Research Center Howard University College of Medicine  Washington District of Columbia USA"},{"name":"Department of Health Policy University of Maryland School of Public Health  College Park Maryland USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Temitope","family":"Ogundare","sequence":"additional","affiliation":[{"name":"Department of Psychiatry Boston School of Medicine  Boston Massachusetts USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mojisola","family":"Fasokun","sequence":"additional","affiliation":[{"name":"Department of Epidemiology University of Alabama at Birmingham  Birmingham Alabama USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Vania","family":"Nwokolo","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology Howard University College of Medicine  Washington District of Columbia USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Terhas","family":"Weldeslase","sequence":"additional","affiliation":[{"name":"Department of Surgery Howard University College of Medicine  Washington District of Columbia USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Vanesa","family":"McDonald","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology Howard University College of Medicine  Washington District of Columbia USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lyanne","family":"Colon\u2010Santos","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology Howard University College of Medicine  Washington District of Columbia USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Guoyang","family":"Luo","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology Howard University College of Medicine  Washington District of Columbia USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2024,3,6]]},"reference":[{"key":"e_1_2_9_2_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.amjsurg.2019.12.017"},{"issue":"9","key":"e_1_2_9_3_1","first-page":"575","article-title":"The Affordable Care Act, five years later: Policies, progress, and politics","volume":"40","author":"Reisman M","year":"2015","journal-title":"Pharm Ther"},{"key":"e_1_2_9_4_1","unstructured":"Maryland Insurance Administration Approves.Affordable Care Act premium rates.2023. Accessed September 20 2023.https:\/\/insurance.maryland.gov\/Documents\/newscenter\/newsreleases\/2023\u2010ACA\u2010Approved\u2010Rates\u2010FINAL\u20109162022.pdf"},{"key":"e_1_2_9_5_1","unstructured":"ASPE.Health coverage under the Affordable Care Act: current enrollment trends and state estimates. Accessed September 20 2023.https:\/\/aspe.hhs.gov\/reports\/current\u2010health\u2010coverage\u2010under\u2010affordable\u2010care\u2010act.https:\/\/aspe.hhs.gov\/sites\/default\/files\/documents\/8e81cf90c721dbbf58694c98e85804d3\/health\u2010coverage\u2010under\u2010aca.pdf"},{"key":"e_1_2_9_6_1","doi-asserted-by":"publisher","DOI":"10.1007\/s11606-018-4598-0"},{"key":"e_1_2_9_7_1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2018.0030"},{"key":"e_1_2_9_8_1","doi-asserted-by":"publisher","DOI":"10.7759\/cureus.41360"},{"key":"e_1_2_9_9_1","unstructured":"Centers for Disease Control and Prevention.Diabetes.2022. Gestational diabetes. Accessed August 20 2023.https:\/\/www.cdc.gov\/diabetes\/basics\/gestational.html"},{"key":"e_1_2_9_10_1","doi-asserted-by":"publisher","DOI":"10.7759\/cureus.29400"},{"key":"e_1_2_9_11_1","first-page":"67","article-title":"Not all C\u2010sections are the same: investigating emergency vs. elective C\u2010section deliveries as an adverse pregnancy outcome","volume":"26","author":"Silvia P","year":"2021","journal-title":"Pac Symp Biocomput"},{"key":"e_1_2_9_12_1","unstructured":"Healthcare Cost & Utilization Project.State Inpatient Databases (SID) database documentation. SID database documentation. n.d. Accessed September 10 2023.https:\/\/hcup\u2010us.ahrq.gov\/db\/state\/siddbdocumentation.jsp"},{"key":"e_1_2_9_13_1","volume-title":"Vital Statistics Online Data Portal","author":"CDC\/NCHS","year":"2023"},{"key":"e_1_2_9_14_1","doi-asserted-by":"publisher","DOI":"10.1186\/s13104-022-06141-w"},{"key":"e_1_2_9_15_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamapediatrics.2013.4347"},{"key":"e_1_2_9_16_1","doi-asserted-by":"publisher","DOI":"10.1377\/hlthaff.2019.01042"},{"key":"e_1_2_9_17_1","doi-asserted-by":"publisher","DOI":"10.2105\/ajph.2015.302903"},{"key":"e_1_2_9_18_1","doi-asserted-by":"publisher","DOI":"10.7861\/fhj.2020-0233"},{"key":"e_1_2_9_19_1","volume-title":"Health Insurance is a Family Matter","author":"Institute of Medicine Committee on the Consequences of Uninsurance","year":"2002"}],"container-title":["International Journal of Gynecology &amp; Obstetrics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/obgyn.onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/ijgo.15439","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,7,17]],"date-time":"2024-07-17T04:24:58Z","timestamp":1721190298000},"score":1,"resource":{"primary":{"URL":"https:\/\/obgyn.onlinelibrary.wiley.com\/doi\/10.1002\/ijgo.15439"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,3,6]]},"references-count":18,"journal-issue":{"issue":"2","published-print":{"date-parts":[[2024,5]]}},"alternative-id":["10.1002\/ijgo.15439"],"URL":"https:\/\/doi.org\/10.1002\/ijgo.15439","archive":["Portico"],"relation":{},"ISSN":["0020-7292","1879-3479"],"issn-type":[{"value":"0020-7292","type":"print"},{"value":"1879-3479","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,3,6]]},"assertion":[{"value":"2023-12-06","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2024-02-07","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2024-03-06","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}