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[Research-action on medical and social management of uninsured pregnant women].

INTRODUCTION
Perinatal morbidity is increased among women without health insurance and/or receiving poor antenatal care. The objectives of this study were to estimate the prevalence of such situations, to analyze underlying social conditions, to identify possible means to secure health insurance and to assess the impact of the absence of health insurance on antenatal care and pregnancy outcomes.


MATERIAL AND METHODS
All pregnant women without health insurance during one calendar year were included. Those who delivered a live child were compared with a control group of women with health insurance who delivered a live child until the date of the last delivery for uninsured women. Statistical analyses were conducted to describe the characteristics of uninsured women and to identify risk factors for poor antenatal care and pregnancy outcomes.


RESULTS
A total of 259 uninsured women were enrolled, including 201 (78%) foreigners the majority of whom had resided in France for more than one year; 205 were followed-up and delivered in our hospital, including 192 live births. The social context of uninsured French women was worse than that of foreign uninsured women. Health insurance was obtained for 85% (173/205). Overall, the absence of health insurance was associated with increased risks for poor antenatal care. Being uninsured and receiving poor antenatal care was associated with an increase in the incidence of intra-uterine growth failure. Post-term deliveries were more frequent among women with poor antenatal care.


CONCLUSIONS
Improving antenatal care and health insurance coverage could help decrease perinatal morbidity, given the current increase in the number of women with social risk factors. It seems essential that all women obtain access to public maternity wards, and that these wards develop effective social services working in concert with ambulatory health and social workers.