{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,17]],"date-time":"2026-09-17T23:05:06Z","timestamp":1789686306984,"version":"4.0.1"},"reference-count":6,"publisher":"Georg Thieme Verlag KG","funder":[{"name":"National Institutes of Health","award":["1R21MD019391-01"],"award-info":[{"award-number":["1R21MD019391-01"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Am J Perinatol"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>Pregnant Medicare beneficiaries are typically individuals with chronic conditions causing disability or end-stage organ disease, which may increase obstetric risk. Few studies have examined this population. We compared medical comorbidities and perinatal outcomes between Medicare-insured and non-Medicare-insured obstetric patients.<\/jats:p>\n                  <jats:p>We performed a cross-sectional analysis of the 2019 Healthcare Cost and Utilization Project National Inpatient Sample, including singleton deliveries (Major Diagnostic Category 14). Using discharge weights, strata, and hospital clusters, we compared Medicare with all other payers across maternal demographics, chronic conditions, and perinatal outcomes, including severe maternal morbidity (SMM). Relative risks (RR) were estimated from survey-weighted log-link quasi-Poisson models; a two-sided \u03b1\u2009&lt;\u20090.05 indicated significance.<\/jats:p>\n                  <jats:p>Of 3,697,605 deliveries, 28,855 were Medicare-insured. Medicare beneficiaries were more likely to be Black (33.3 vs. 9.5%) and of advanced maternal age (25.4 vs. 23.4%) and had higher rates of chronic kidney disease, prepregnancy hypertension and diabetes, cesarean delivery (37.7 vs. 35.1%), and preterm birth (13.6 vs. 7.5%) than privately insured patients (all p\u2009&lt;\u20090.001). Relative to Medicare, privately insured patients had lower risk of SMM (RR: 0.28; 95% confidence interval: 0.25\u20130.32).<\/jats:p>\n                  <jats:p>Pregnant Medicare beneficiaries enter pregnancy with a higher chronic disease burden and experience worse maternal and perinatal outcomes, highlighting the need for targeted support of this vulnerable population.<\/jats:p>","DOI":"10.1055\/a-2954-5263","type":"journal-article","created":{"date-parts":[[2026,9,17]],"date-time":"2026-09-17T22:37:42Z","timestamp":1789684662000},"source":"Crossref","is-referenced-by-count":0,"title":["Perinatal Risk and Outcomes Among Individuals Insured by Medicare"],"prefix":"10.1055","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7439-9021","authenticated-orcid":false,"given":"Osinakachukwu","family":"Mbata","sequence":"additional","affiliation":[{"name":"Duke University School of Medicine, North Carolina, United States","place":["Durham"],"department":["Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ayodamope","family":"Fawole","sequence":"additional","affiliation":[{"name":"Duke University, North Carolina, United States","place":["Durham"],"department":["Global Health Institute"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Armand","family":"Zimmerman","sequence":"additional","affiliation":[{"name":"Duke University, North Carolina, United States","place":["Durham"],"department":["Global Health Institute"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Muskaan","family":"Toshniwal","sequence":"additional","affiliation":[{"name":"Duke University, North Carolina, United States","place":["Durham"],"department":["Global Health Institute"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Evan","family":"Myers","sequence":"additional","affiliation":[{"name":"Duke University School of Medicine, North Carolina, United States","place":["Durham"],"department":["Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine"]},{"name":"Duke University, North Carolina, United States","place":["Durham"],"department":["Duke-Margolis Institute for Health Policy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maria","family":"Small","sequence":"additional","affiliation":[{"name":"Duke University School of Medicine, North Carolina, United States","place":["Durham"],"department":["Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine"]},{"name":"Duke University, North Carolina, United States","place":["Durham"],"department":["Global Health Institute"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Osondu","family":"Ogbuoji","sequence":"additional","affiliation":[{"name":"Duke University, North Carolina, United States","place":["Durham"],"department":["Global Health Institute"]},{"name":"Duke University, North Carolina, United States","place":["Durham"],"department":["Duke-Margolis Institute for Health Policy"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"194","published-online":{"date-parts":[[2026,9,17]]},"reference":[{"issue":"02","key":"ref2","first-page":"179","article-title":"Thirty years of Medicare: impact on the covered population","volume":"18","author":"M E Gornick","year":"1996","journal-title":"Health Care Financ Rev"},{"issue":"12","key":"ref6","doi-asserted-by":"crossref","first-page":"3702","DOI":"10.1007\/s11606-019-05327-6","article-title":"An overview of Medicare for clinicians","volume":"35","author":"W El-Nahal","year":"2020","journal-title":"J Gen Intern Med"},{"issue":"04","key":"ref8","doi-asserted-by":"crossref","first-page":"914","DOI":"10.1111\/1475-6773.14150","article-title":"Assessing the difference in racial and ethnic disparities in access to and use of care between Traditional Medicare and Medicare Advantage","volume":"58","author":"A Gangopadhyaya","year":"2023","journal-title":"Health Serv Res"},{"key":"ref16","doi-asserted-by":"crossref","first-page":"S40","DOI":"10.1097\/MLR.0b013e3182610aa5","article-title":"Racial\/ethnic disparities in Medicare Part D experiences","volume":"50","author":"A M Haviland","year":"2012","journal-title":"Med Care"},{"issue":"03","key":"ref20","doi-asserted-by":"crossref","first-page":"e62","DOI":"10.1097\/AOG.0000000000005678","article-title":"ACOG Committee Statement No. 10: racial and ethnic inequities in obstetrics and gynecology","volume":"144","author":"American College of Obstetricians and Gynecologists' Committee on Advancing Equity in Obstetric and Gynecologic Health Care","year":"2024","journal-title":"Obstet Gynecol"},{"issue":"01","key":"ref21","doi-asserted-by":"crossref","first-page":"122.e1","DOI":"10.1016\/j.ajog.2015.08.019","article-title":"Black-white differences in severe maternal morbidity and site of care","volume":"214","author":"E A Howell","year":"2016","journal-title":"Am J Obstet Gynecol"}],"container-title":["American Journal of Perinatology"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/www.thieme-connect.de\/products\/ejournals\/pdf\/10.1055\/a-2954-5263.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,17]],"date-time":"2026-09-17T22:37:43Z","timestamp":1789684663000},"score":1,"resource":{"primary":{"URL":"http:\/\/www.thieme-connect.de\/DOI\/DOI?10.1055\/a-2954-5263"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,9,17]]},"references-count":6,"URL":"https:\/\/doi.org\/10.1055\/a-2954-5263","archive":["Portico","CLOCKSS"],"relation":{},"ISSN":["0735-1631","1098-8785"],"issn-type":[{"value":"0735-1631","type":"print"},{"value":"1098-8785","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,9,17]]}}}