761: Reversal of intention for elective termination of pregnancy is associated with inadequate prenatal care utilization

Abstract

More than half of all pregnancies in the U.S. are unintended; 18% result in elective termination of pregnancy (TOP). Some women seek TOP but ultimately elect for pregnancy continuation. This subset is more likely to have delayed entry into care and less likely to attend a postpartum visit. Data is limited about their utilization of routine prenatal care. The purpose of this study was to determine if reversal of intention for TOP is associated with differences in prenatal care (PNC) utilization. Retrospective cohort study of subjects presenting for obstetrical dating ultrasound (US) from 2011-2017 at academic medical center offering TOP until 24 weeks. “Contemplators” (CON) were subjects completing US with intention of TOP who instead continued the same pregnancy to live birth. A 2:1 group of non-contemplators (NCON) were selected who completed US and continued to live birth. Primary outcome was difference in PNC utilization; adequate PNC defined as “Adequacy of Prenatal Care Utilization Index” (API) score ≥14 points. Secondary outcomes included median API score, adverse pregnancy outcomes, and postpartum contraception plan. There were 93 CON and 186 NCON. Significant demographic differences noted between groups (Table 1). Inadequate PNC utilization was more common in CON compared to NCON (47.3% vs 71.0%; OR 0.70 (0.57-0.86); p< 0.01). Significance remained after adjusting for differences in maternal characteristics (aOR 0.48 (0.28-0.90)). CON had significantly lower scores on API (median 13 (2-18) vs 15 (5-18), p< 0.01). No differences in adverse pregnancy outcomes between groups (Table 2). A post-partum contraception plan was significantly higher in CON (aOR 4.16 (1.83-9.47); p< 0.01). Reversal of intention for TOP is associated with inadequate PNC utilization. The study was underpowered to detect a difference in adverse pregnancy outcomes. Focus towards interventions to address this health care disparity in this population is imperative.View Large Image Figure ViewerDownload Hi-res image Download (PPT)