1135: Increasing rate of no prenatal care in pregnancies complicated by Hepatitis C in the US

Abstract

Despite efforts to expand access to prenatal care under the umbrella of Healthy People 2020, certain populations of women continue to be at risk for not accessing prenatal care. We aim to describe the relationship between no prenatal care (PNC) with pregnancies complicated by Hepatitis C in the US. Population-based retrospective cohort study of all US live births from 2012-2016 using vital statistic records. Quantity of PNC is recorded on the US certificate of live birth as “total number of prenatal visits” for the pregnancy. No PNC was defined as zero prenatal visits, and inadequate PNC defined as < 50% of recommended number of visits adjusted for gestational age at birth using the Kessner Index. Presence of Hepatitis C (Hep C) is also recorded on the US birth certificate. Frequency of no PNC was calculated per year among all live births (20-42 wks) and compared to births to mothers with Hep C. The rate of no PNC overall during the study period was 1.47%, increasing from 1.36% in 2012 to 1.58% in 2016, p< 0.001. Of the 19,547,691 births analyzed, 0.29% mothers had Hep C. Among births to mothers with Hep C, the rate of no PNC rose from 1.21% to 6.31%, greater than 5-fold increase, p< 0.001. The largest annual increase of no PNC with Hep C was in 2014 with a 3.5-fold increase over 1 year, an increase not similarly observed in the overall population (figure). Rates of inadequate prenatal care similarly increased in women with Hep C during the study period. The overall rate of no PNC in the US rose slightly from 2012-2016. However, the rate increased more dramatically among women with Hep C. This may be related to higher rates of maternal substance use disorders among women with Hep C, particularly intravenous drug use. Mothers’ perceptions of negative legal ramifications of having illicit drug use identified during pregnancy may lead to avoidance of prenatal care. Public health initiatives should focus on improving access to care for women with high-risk pregnancy conditions, especially as rates of substance abuse disorders and Hepatitis C are on the risk in the US.View Large Image Figure ViewerDownload Hi-res image Download (PPT)