Initiation Of Prenatal Care Research Articles

Prenatal Cannabis Use and Offspring Attention Deficit Hyperactivity Disorder and Disruptive Behavior Disorders: A Retrospective Cohort Study.

To examine whether maternal cannabis use during early pregnancy is associated with offspring attention deficit hyperactivity disorder (ADHD) and disruptive behavior disorders (DBD). We conducted a population-based retrospective birth cohort study of children (N = 141,570) born between 2011 and 2018 to pregnant individuals (N = 117,130) in Kaiser Permanente Northern California universally screened for any prenatal cannabis use at the entrance to prenatal care (at ∼8-10 wk gestation). Prenatal cannabis use was defined as (1) self-reported use and/or a positive toxicology test, (2) self-reported use, (3) a positive toxicology test, and (4) self-reported use frequency. Cox proportional hazards regression models adjusting for maternal characteristics (sociodemographics, other substance use and substance use disorders, prenatal care initiation, comorbidities) examined associations between prenatal cannabis use and offspring ADHD and DBD diagnosed by age 11 years. The sample of pregnant individuals was 27.2% Asian/Pacific Islander, 5.7% Black, 24.5% Hispanic, and 38.8% non-Hispanic White, with a mean (SD) age of 30.9 (5.2) years; 4.6% screened positive for any cannabis use (0.4% daily, 0.5% weekly, 1.1% monthly or less, 2.7% unknown frequency); 3.92% had a positive toxicology test and 1.8% self-reported use; 7.7% of offspring had ADHD and 6.8% had DBD. Maternal prenatal cannabis use was not associated with ADHD (adjusted hazard ratio [aHR]: 0.84, 95% CI, 0.70-1.01), and there was an inverse association with DBD (aHR: 0.83, 95% CI, 0.71-0.97), which remained when cannabis was defined by toxicology testing but not by self-report. Frequency of use was not associated with outcomes. Maternal prenatal cannabis use was not associated with an increased risk of offspring ADHD or DBD.

Maternal Prenatal Cannabis Use and Child Autism Spectrum Disorder

Despite an increase in maternal prenatal cannabis use and associations with adverse neonatal outcomes, research on child neurodevelopmental outcomes is limited. To evaluate the association between maternal cannabis use in early pregnancy and child autism spectrum disorder (ASD). This population-based retrospective birth cohort study included children born between 2011 and 2019 to pregnant Kaiser Permanente Northern California members screened for prenatal cannabis use during pregnancy. Statistical analysis was conducted February 2023 to March 2024. Maternal prenatal cannabis use was assessed at entrance to prenatal care (approximately 8- to 10-weeks' gestation) via self-report and/or positive urine toxicology test. Use frequency was assessed. Child ASD was defined by International Statistical Classification of Diseases and Related Health Problems, Tenth Revision (ICD-10) diagnosis codes ascertained from the electronic health record. Associations between maternal prenatal cannabis use and child ASD were modeled using Cox proportional hazards regression adjusted for maternal sociodemographic, other substance use and disorders, prenatal care initiation, comorbidities, and clustering among maternal siblings. The study cohort included 178 948 singleton pregnancies among 146 296 unique pregnant individuals, including 48 880 (27.3%) Asian or Pacific Islander, 42 799 (23.9%) Hispanic, 9742 (5.4%) non-Hispanic Black, and 70 733 (39.5%) non-Hispanic White pregnancies. The median (IQR) maternal age at pregnancy onset was 31 (6) years; 8486 (4.7%) screened positive for cannabis use, 7054 (3.9%) via urine toxicology testing and 3662 (2.0%) by self-report. In the total study population, the frequency of self-reported use was monthly or less for 2003 pregnancies (1.1%), weekly for 918 pregnancies (0.5%), daily for 741 pregnancies (0.4%), and unknown for 4824 pregnancies (2.7%). ASD was diagnosed in 3.6% of children. After adjustment for maternal characteristics, maternal prenatal cannabis use was not associated with child ASD (hazard ratio [HR], 1.05; 95% CI, 0.84-1.32). When self-reported frequency of use was assessed, no statistically significant associations were observed after confounder adjustment. No sex-specific associations were documented (males: HR, 1.01; 95% CI, 0.77-1.32; and females: HR, 1.19; 95% CI, 0.77-1.85). In this cohort study, maternal cannabis use assessed in early pregnancy was not associated with child ASD. Additional studies are needed to evaluate different patterns of use throughout pregnancy. Given the known adverse neonatal health effects of maternal prenatal cannabis use, clinicians should follow national guidelines and advise against use.

Prenatal Care Utilization and Birth Outcomes After Expansion of the National Health Service Corps.

The National Health Service Corps (NHSC) attracts clinicians to Health Professional Shortage Areas (HPSAs) through scholarships and loan repayments. Since 2009, the NHSC workforce, including maternity care clinicians, has substantially expanded. This study evaluates the association between NHSC expansion and prenatal care and birth outcomes. In this quasi-experimental study, we adopted a generalized difference-in-differences design to compare changes in prenatal care and birth outcomes from 2005 to 2019 using birth certificate data. Counties designated as HPSAs without any NHSC maternity care clinicians throughout the study period were control counties, and those without such clinicians before 2009 but receiving them after 2009 were treated counties. Outcome measures include a count variable of number of prenatal visits and four dichotomous variables: prenatal care initiation in the first trimester, adequacy of prenatal care, preterm birth, and low birth weight. We estimated negative binomial models for number of prenatal visits and linear probability models for the dichotomous outcomes, adjusting for maternal characteristics, non-NHSC clinician density, and state-level policies. Stratified analyses were also conducted on the basis of birthing people's demographics and county-level characteristics. Our sample comprised 12,980,111 live births between 2005 and 2019 by individuals residing in 1,254 HPSA counties without any NHSC maternity care clinicians before 2009, including 222 counties that received such clinicians after 2009. Compared with control counties, pregnant people in treated counties experienced significant increases in prenatal visits (211 more prenatal visits relative to baseline of 11,226 visits per 1,000 births, P<.001) and in the likelihood of receiving adequate prenatal care (1.43 percentage point increase relative to baseline of 67.0 percentage points, P<.01). Although the NHSC expansion improved prenatal care use for all racial and ethnic groups, pregnant people residing in urban and high social vulnerability areas benefited most. Improvements in birth outcomes were observed only among certain subgroups such as a 0.91 percentage point reduction in preterm birth (relative to baseline of 12.6 percentage points, P<.001) and a 0.87 percentage point reduction in low birth weight (relative to baseline of 8.2 percentage points, P<.05) among pregnant people living in full-county HPSAs. The NHSC expansion since 2009 was associated with increases in prenatal care utilization, particularly among vulnerable populations. Although improvements were not observed in birth outcomes overall with NHSC expansion, modest reductions were observed in preterm birth and low birth weight in subsets of the population.

The association of travel burden with prenatal care utilization, what happens after provider-selection

BackgroundBirthing people in the United States face numerous challenges when accessing adequate prenatal care (PNC), with transportation being a significant obstacle. Nevertheless, previous studies that relied solely on the distance to the nearest provider cannot differentiate the effects of travel burden on provider selection and care utilization. These may exaggerate the degree of inequality in access and fail to capture perceived travel burden. This study investigated whether travel distances to the initially visited provider, to the predominant PNC provider, and perceived travel burden (measured by the travel disadvantage index (TDI)) are associated with PNC utilization.MethodsA retrospective cohort of people with live births were identified from South Carolina Medicaid claims files in 2015–2018. Travel distances were calculated using Google Maps. The estimated TDI was derived from local pilot survey data. PNC utilization was measured by PNC initiation and frequency. Repeated measure logistic regression test was utilized for categorical variables and one-way repeated measures ANOVA for continuous variables. Unadjusted and adjusted ordinal logistic regressions with repeated measure were utilized to examine the association of travel burdens with PNC usage.ResultsFor 25,801 pregnancies among those continuously enrolled in Medicaid, birthing people traveled an average of 24.9 and 24.2 miles to their initial and predominant provider, respectively, with an average TDI of -11.4 (SD, 8.5). Of these pregnancies, 60% initiated PNC in the first trimester, with an average of 8 total visits. Compared to the specialties of initial providers, predominant providers were more likely to be OBGYN-related specialists (81.6% vs. 87.9%, p < .001) and midwives (3.5% vs. 4.3%, p < .001). Multiple regression analysis revealed that every doubling of travel distance was associated with less likelihood to initiate timely PNC (OR: 0.95, p < .001) and a lower visit frequency (OR: 0.85, p < .001), and every doubling of TDI was associated with less likelihood to initiate timely PNC (OR: 0.94, p = .04).ConclusionsFindings suggest that the association between travel burden and PNC utilization was statistically significant but of limited practical significance.

Patient-perceived barriers to early initiation of prenatal care at a large, urban federally qualified health center: a mixed-methods study

BackgroundEarly initiation of prenatal care is widely accepted to improve the health outcomes of pregnancy for both mothers and their infants. Identification of the various barriers to entry into care that patients experience may inform and improve health care provision and, in turn, improve the patient’s ability to receive necessary care.AimThis study implements a mixed-methods approach to establish methods and procedures for identifying barriers to early entry to prenatal care in a medically-vulnerable patient population and areas for future quality improvement initiatives.MethodsAn initial chart review was conducted on obstetrics patients that initiated prenatal care after their first trimester at a large federally qualified health center in Brooklyn, NY, to determine patient-specified reasons for delay. A thematic analysis of these data was implemented in combination with both parametric and non-parametric analyses to characterize the population of interest, and to identify the primary determinants of delayed entry.ResultsThe age of patients in the population of interest (n = 169) was bimodal, with a range of 15 – 43 years and a mean of 28 years. The mean gestational age of entry into prenatal care was 19 weeks. The chart review revealed that 8% recently moved to Brooklyn from outside of NYC or the USA. Nine percent had difficulty scheduling an initial prenatal visit within their first trimester. Teenage pregnancy accounted for 7%. Provider challenges with documentation (21%) were noted. The most common themes identified (n = 155) were the patient being in transition (21%), the pregnancy being unplanned (17%), and issues with linkage to care (15%), including no shows or patient cancellations. Patients who were late to prenatal care also differed from their peers dramatically, as they were more likely to be Spanish-speaking, to be young, and to experience a relatively long delay between pregnancy confirmation and entry into care. Moreover, the greatest determinant of delayed entry into care was patient age.ConclusionOur study provides a process for other like clinics to identify patients who are at risk for delayed entry to prenatal care and highlight common barriers to entry. Future initiatives include the introduction of a smart data element to document reasons for delay and use of community health workers for dedicated outreach after no show appointments or patient cancellations.

Women’s country of birth and failure to catch up an overdue cervical cancer cytological screening participation during pregnancy in France, an observational study based on survey sources

BackgroundCervical cancer is the fourth most common cancer among women worldwide, both for incidence and mortality. Prevention relies on screening with a Pap test to detect precancerous lesions, which can then be treated. Access to this screening is currently both improvable and inequitable. Pregnancy may be an ideal moment for women to catch up on their overdue cervical cancer screening. In the general population, women's risk of not being screened is associated with their place of birth and other social factors; this may be true as well among pregnant women. Our objective was to study the association between women's place of birth and their failure to catch up with this screening during pregnancy.MethodsThe 2016 French National Perinatal Survey included 13,147 women who gave birth after 21 weeks of gestation. The association between their place of birth and failure to catch up on this screening (defined by the absence of a Pap test during pregnancy for women overdue for it) was adjusted for age, parity, education level, health insurance, and when they began prenatal care with logistic regression models.ResultsAmong the women for whom screening was then recommended, 49% were not up to date at the start of pregnancy, and of these, 53% were not caught up before delivery. After adjustment for other risk factors, maternal place of birth was not associated with a higher risk of failure to catch up with this screening during pregnancy. However, factors identified as associated with this risk included a low education level and late start of prenatal care.ConclusionAbout half of women overdue for cervical cancer screening did not catch up with it during their pregnancy. Professionals should pay special attention to women with lower education levels and late initiation of prenatal care, who constitute a group at high risk of not catching up on this screening during pregnancy.

The Association Between Unintended Pregnancy and Perinatal Outcomes in Low-Risk Pregnancies: A Retrospective Registry Study in the Netherlands.

People with unintended pregnancies might be at increased risk of adverse perinatal outcomes due to structural factors, distress, or delayed prenatal care. Existing studies addressing this association yielded inconsistent findings. Using contemporary data from a large Dutch midwifery care registry, we investigated the association between unintended pregnancy ending in birth and neonatal outcomes, parental morbidity, and obstetric interventions. We extend previous research by exploring whether delayed initiation of prenatal care mediates these associations. This study used data (N = 9803) from a Dutch nationally representative registry of people with low-risk pregnancies receiving primary midwife-led care in the Netherlands between 2012 and 2020. Using logistic (mediation) regression analyses adjusted for potential confounders we investigated associations between unintended pregnancy and neonatal outcomes (low Apgar score, small for gestational age, and prematurity), parental morbidity (hypertension and gestational diabetes mellitus), and obstetric interventions (induction of labor, pain medication, assisted vaginal birth, and cesarean birth) and whether delayed initiation of prenatal care mediated these associations. Unintended pregnancies were associated with increased odds of low Apgar scores (odds ratio [OR], 1.68; 95% CI, 1.09 -2.59), preterm birth (OR, 1.27; 95% CI, 1.02-1.58), small for gestational age (OR, 1.19; 95% CI, 1.00-1.41), and induction of labor (OR, 1.14; 95% CI, 1.01-1.28). Conversely, unintended pregnancy was associated with a decreased odds of cesarean birth (OR, 0.83; 95% CI, 0.71-0.97). The timing of prenatal care initiation did not mediate any of these associations. Our findings suggest that people in primary midwifery-led care with unintended pregnancies ending in birth are at increased risk for adverse perinatal health outcomes and that structural factors might underlie this link. Health care professionals and policy makers should attend to their own biases and offer nonjudgmental, tailored preventive preconception care and antenatal care strategies for people with higher vulnerabilities.

Race and Place Matter: Inequity in Prenatal Care for Reservation-Dwelling American Indian People.

Early initiation and consistent use of prenatal care is linked with improved health outcomes. American Indian birthing people have higher rates of inadequate prenatal care (IPNC), but limited research has examined IPNC among people living on American Indian reservations. The current study uses birth certificate data from the state of Montana (n = 57,006) to examine predictors of IPNC. Data on the community context is integrated to examine the role of community health in mediating the associations between reservation status and IPNC. Results suggest that reservation-dwelling birthers are more likely to have IPNC, an association partially mediated by community health. Odds of IPNC are higher for reservation-dwelling American Indian people compared to reservation-dwelling White birthers, highlighting intersecting inequalities of race and place.

Prevalence of Late Antenatal Booking and its Complications at Hayatabad Medical Complex

Background: Timely initiation of prenatal care is pivotal for maternal and fetal health, facilitating the early detection and management of potential pregnancy-related complications. Despite the known benefits, late antenatal booking remains a significant challenge, potentially leading to adverse pregnancy outcomes. This study investigates the prevalence of late antenatal booking and its associated complications, contributing to a broader understanding of its determinants and impacts. Objective: To explore the prevalence of late antenatal booking among pregnant women attending Hayatabad Medical Complex, Peshawar, and to identify the associated complications and factors contributing to late booking. Methods: This descriptive research study was conducted from August 2021 to July 2023, involving 1920 pregnant women aged 18 years and above, receiving antenatal care at the Gynaecology &amp; Obstetric Department of Hayatabad Medical Complex, Peshawar. Participants were selected through systematic sampling. Data were collected using structured questionnaires covering demographic information, medical history, timing of antenatal care initiation, reasons for late booking, and awareness of potential complications. Late antenatal booking was defined as the initiation of care beyond 24 weeks of gestation. Statistical analysis was performed using SPSS version 25.0, employing descriptive statistics, Chi-squared tests, or Fisher's exact tests, with statistical significance set at p ≤ 0.05. Results: The study found a late antenatal booking prevalence of 16.67%. Preterm birth occurred in 26% of cases with late booking, and low birth weight was observed in 15.9% of infants born to these women. The highest rate of late booking was among women aged 36+ (25%) and those with higher education (22.1%). Major barriers to timely antenatal care included a lack of awareness (42.5%), financial constraints (31.2%), and fear of healthcare facilities (20.9%). Conditions such as maternal anemia and hypertension were more prevalent among women with late bookings, at rates of 12.5% for hypertension and significant incidences of placental abruption and intrauterine death. Conclusion: Late antenatal booking is associated with significant adverse pregnancy outcomes, highlighting the need for targeted public health campaigns and healthcare system improvements to promote early and regular antenatal care access. Addressing educational, economic, and perceptual barriers is essential for improving prenatal care utilization.

Factors Associated with the Uptake of Long-Acting Reversible Contraception and Contraceptive Use in Postpartum People with HIV at a Single Tertiary Care Center.

This study aimed to elucidate factors contributing to uptake of highly effective contraception, including permanent contraception, and no contraceptive plan among postpartum people with HIV (PWHIV). A retrospective cohort analysis was conducted to correlate postpartum birth control (PPBC) with sociodemographic and biomedical variables among postpartum PWHIV who received care at The Ruth M. Rothstein CORE Center and delivered at John H. Stroger, Jr. Hospital of Cook County in Chicago, from 2012 to 2020. Earlier gestational age (GA) at initiation of prenatal care, having insurance, and increased parity are associated with uptake of highly effective contraception. Meanwhile, later GA at presentation increased odds of having no PPBC plan. Early prenatal care, adequate insurance coverage, and thorough PPBC counseling are important for pregnant PWHIV. · Contraceptive use among PWHIV is poorly understood.. · Having insurance and increased parity are associated with long-acting reversible contraception use.. · Earlier GA at first prenatal care visit is associated with increased PPBC uptake..

Prenatal Care Initiation and Exposure to Teratogenic Medications

With new legal abortion restrictions, timing of prenatal care initiation is critical to allow for discussion of reproductive options among pregnancies exposed to teratogenic medications. To investigate the prevalence of prenatal exposure to teratogenic medications and prenatal care initiation across gestational weeks. This descriptive, population-based cross-sectional study used health encounter data from a national sample of individuals with employer-sponsored health insurance. A validated algorithm identified pregnancies among persons identifying as female that ended with a live or nonlive outcome between January 2017 and December 2019. Data were analyzed from December 2022 to December 2023. Prenatal exposure to any of 137 teratogenic medications, measured via pharmacy and medical claims. Measurement of prenatal care initiation was adapted from the Children's Health Care Quality Measures. Prevalence of prenatal exposure to teratogens and prenatal care initiation by gestational week. Timing of prenatal teratogenic exposure was compared with timing of prenatal care initiation and legal abortion cutoffs. Among 639 994 pregnancies, 472 472 (73.8%; 95% CI, 73.7%-73.9%) had a live delivery (mean [SD] age, 30.9 [5.4] years) and 167 522 (26.2%; 95% CI, 26.1%-26.3%) had a nonlive outcome (mean [SD] age, 31.6 [6.4] years). Of pregnancies with live deliveries, 5.8% (95% CI, 5.7%-5.8%) were exposed to teratogenic medications compared with 3.1% (95% CI, 3.0%-3.2%) with nonlive outcomes. Median time to prenatal care was 56 days (IQR, 44-70 days). By 6 weeks' gestation, 8186 pregnancies had been exposed to teratogenic medications (25.2% [95% CI, 24.7%-25.7%] of pregnancies exposed at any time during gestation; 1.3% [95% CI, 1.3%-1.3%] of all pregnancies); in 6877 (84.0%; 95% CI, 83.2%-84.8%), prenatal care was initiated after 6 weeks or not at all. By 15 weeks, teratogenic exposures had occurred for 48.9% (95% CI, 48.4%-49.5%) of all teratogen-exposed pregnancies (2.5% [2.4-2.5] of all pregnancies); prenatal care initiation occurred after 15 weeks for 1810 (16.8%; 95% CI, 16.1%-17.5%) with live deliveries and 2975 (58.3%; 95% CI, 56.9%-59.6%) with nonlive outcomes. Teratogenic medications most used within the first 15 gestational weeks among live deliveries included antiinfectives (eg, fluconazole), anticonvulsants (eg, valproate), antihypertensives (eg, lisinopril), and immunomodulators (eg, mycophenolate). For nonlive deliveries, most antihypertensives were replaced by vitamin A derivatives. In this cross-sectional study, most exposures to teratogenic medications occurred in early pregnancy and before prenatal care initiation, precluding prenatal risk-benefit assessments. Prenatal care commonly occurred after strict legal abortion cutoffs, prohibiting consideration of pregnancy termination if concerns about teratogenic effects arose.

Giving Birth With a Midwife in Attendance: Associations of Race and Insurance Status With Continuity of Midwifery Care in Philadelphia.

From 2013 to 2019, Black women comprised 73% of pregnancy-related deaths in Philadelphia. There is currently a dearth of research on the continuity of midwifery care from initiation of prenatal care through birth in relation to characteristics such as race/ethnicity and income. The aim of this study was to investigate whether race/ethnicity and insurance status were associated with the likelihood of a pregnant person who begins prenatal care with a midwife to remain in midwifery care for birth attendance. This was a retrospective cohort study of a diverse population of pregnant patients who gave birth in a large tertiary care hospital and had their first prenatal visit with a certified nurse-midwife (CNM) between June 2, 2009, and June 30, 2020 (n = 5121). We used multivariable, log-binomial regression models to calculate risk ratios of transferring to physician care (vs remaining within CNM care), adjusted for age, race/ethnicity, prepregnancy body mass index, insurance type, and comorbidities. After adjusting for pregnancy-related risk factors, non-Hispanic Black patients (adjusted relative risk [aRR], 1.14; 95% CI, 1.04-1.24) and publicly insured patients (aRR, 1.11; 95% CI, 1.01-1.22) were at higher risk of being transferred to physician care compared with non-Hispanic White and privately insured patients. Secondary analysis revealed that non-Hispanic Black patients had higher risk of transferring and having an operative birth (aRR, 1.35; 95% CI, 1.18-1.55), whereas publicly insured patients were at higher risk of being transferred for reasons other than operative births (aRR, 1.35; 95% CI, 1.18-1.54). These findings indicate that Black and publicly insured patients were more likely than White and privately insured patients to transfer to physician care even after adjustment for comorbid conditions. Thus, further research is needed to identify the factors that contribute to racial and economic disparity in continuity of midwifery care.

African immigrants' favorable preterm birth rates challenge genetic etiology of the Black-White disparity in preterm birth.

We examined over a million California birth records for 2010 through 2021 to investigate whether disparities in preterm birth (PTB) by nativity and race support the widely held but hitherto unsubstantiated belief that genetic differences explain the persistent Black-White disparity in PTB. We examined PTB rates and risk ratios among African-, Caribbean-, and U.S.-born Black women compared to U.S.-born White women. Multivariate analyses adjusted for maternal age, education, number of live births, delivery payer, trimester of prenatal care initiation, pre-pregnancy BMI, smoking, and prevalence of poverty in a woman's residence census tract; and for paternal education. In adjusted analyses, African-born Black women's PTB rates were no different from those of U.S.-born White women. The results add to prior evidence making a genetic etiology for the racial disparity in PTB unlikely. If genetic differences tied to "race" explained the Black-White disparity in PTB among U.S.-born women, the African immigrants in this study would have had higher rates of PTB, not the lower rates observed. Multiple explanations for the observed patterns and their implications are discussed. Failure to distinguish causes of PTB from causes of the racial disparity in PTB have likely contributed to erroneous attribution of the racial disparity to genetic differences. Based on the literature, unmeasured experiences of racism, including racism-related stress and adverse environmental exposures, are plausible explanations for the PTB disparity between Black and White U.S.-born women. The favorable birth outcomes of African-born Black immigrants may reflect less exposure to racism during sensitive life periods, e.g., childhood, when they were in African countries, where Black people are in the racial majority.

Acceptance of Routine Vaccines in Pregnancy during the COVID-19 Pandemic.

This study aimed to evaluate the rates of vaccination against infectious diseases (Tetanus, Diphtheria, and Pertussis [Tdap] and influenza) in pregnancy during the coronavirus disease 2019 (COVID-19) pandemic compared to contemporary historical controls. This was a retrospective cohort study comparing rates of Tdap and influenza vaccination in pregnant people who received care at NYU Langone Health and delivered from September 1, 2020, to January 31, 2021 ("COVID cohort") to the same period the prior year ("2019 cohort"). Demographic information, trimester of initiation of prenatal care, insurance status, and medical comorbidities were evaluated. Outcomes were analyzed using chi-square, Fisher's exact test, and multivariable logistic regression, with significance of p < 0.05. In total, 1,713 pregnant people were included. Compared to historical controls, the COVID cohort differed in age, race, timing of initiation of prenatal care, insurance status, and medical comorbidities. After adjusting for these covariates, pregnant people were significantly more likely to accept influenza vaccine in the COVID cohort (adjusted odds ratio [aOR] 1.7, 95% confidence interval [CI] 1.27-2.29) and had similar Tdap acceptance (aOR 1.5, 95% CI 0.99-2.17). However, this trend was not observed for the entire obstetric population; public insurance status and medical comorbidities were associated with lower vaccine rates during the pandemic. For those who had public insurance, rates of influenza vaccination decreased from 83% in 2019 to 40% during COVID (aOR 0.16, 95% CI 0.10-0.24) and for Tdap rates decreased from 93 to 54% (aOR 0.13, 95% CI 0.08-0.21). During the COVID-19 pandemic era, pregnant people at large were more likely to accept the influenza vaccine. However, this trend did not apply to Tdap, and high-risk groups with public insurance and medical comorbidities. This study highlights potential disparities in vaccination rates, which need to be accounted for when evaluating national vaccine trends. These data support increased efforts in vaccine counseling for high-risk populations. · Antenatal flu vaccination increased during the pandemic.. · Antenatal Tdap vaccination was unchanged during the pandemic.. · High-risk pregnant patients had decreased vaccine uptake.. · High-risk subgroups were not included in overarching vaccination trends..

Uninsured immigrants in the United States significantly delayed the initiation of prenatal care after the changes to the Public Charge Rule

ObjectiveWe estimated the impact of the changes made to the Public Charge Rule on the initiation of prenatal care among uninsured immigrants in the United States. Study designWe used a difference-in-differences approach to analyse the impact of the changes made to the Public Charge Rule (first difference) on initiation of prenatal care between uninsured and privately insured immigrants (second difference). MethodsWe used the natality data by the National Center for Health Statistics as the main data source, which includes all singleton births in a hospital to an immigrant birthing person aged from 15 to 44. The study covers three phases: (1) the period prior to the leaked draft Executive Orders concerning changes made to the public charge policy—from January 2014 to December 2016; (2) the period after the draft Executive Orders were leaked until the proposal of the Public Charge Rule—from January 2017 to September 2018; and (3) post proposal of the Public Charge Rule —from October 2018 to December 2019. ResultsAfter the proposal of the Public Charge Rule in 2018, the odds of initiating prenatal care in the first trimester decreased among uninsured immigrants by 12% (odds ratio [OR]: 0.880; 95% confidence interval [CI]: 0.832, 0.931) compared to privately insured immigrants. The odds of second trimester initiation of prenatal care was also negatively associated with the leak of the draft Executive Orders (OR: 0.942; 95% CI: 0.905, 0.981). ConclusionThe results of this study suggest that uninsured immigrants in the United States significantly delayed prenatal care after the changes were made to the Public Charge Rule.

Prevalence and correlates of very rapid repeat pregnancy: Pregnancy Risk Assessment Monitoring System, United States, 2009-2020.

Most rapid repeat pregnancies, defined as those occurring within 18 months of a previous birth, are unintended. These pregnancies are associated with later initiation of prenatal care and are more common among people with lower socio-economic status and among racially and ethnically minoritised populations. To assess prevalence and correlate pregnancies occurring in the immediate period after a live birth in the United States, using the Pregnancy Risk Assessment Monitoring System (PRAMS). We assessed data from the 2009-2020 PRAMS, a population-based survey of perinatal maternal characteristics of mothers of liveborn infants in US locations. We assessed pregnancies reported during the immediate postpartum period (approximately 2-6 months post-delivery), and term this 'very rapid repeat pregnancy' (VRRP). We assessed the adjusted prevalence of VRRP from 2009 to 2020. From 2016 to 2020, we calculated adjusted prevalence ratios (aPR) with 95% confidence intervals (CI) for maternal characteristics. The adjusted prevalence of VRRP ranged from 0.38% (95% CI: 0.29, 0.48) in 2009 to 0.76% (95% CI: 0.61, 0.91) in 2020. Demographic characteristics associated with VRRP included younger age, lower educational attainment, and being unmarried. Black mothers had a higher prevalence of VRRP compared to white mothers. Mothers who attended a healthcare visit in the 12 months preconception had a lower prevalence of VRRP as did mothers who attended a postpartum check-up, compared to their counterparts without these visits. Among those receiving prenatal care, mothers whose prenatal healthcare provider asked about postpartum contraception birth had a lower prevalence of VRRP, compared to those not asked about postpartum contraception. VRRP appeared to increase over time in 2009-2020. Mothers who are younger, Black, have lower educational attainment, or who did not attend healthcare visits before or after pregnancy had a higher prevalence of VRRP and may comprise a population who would benefit from additional family planning resources.

Maternal andNeonatal Outcomes ofAdolescent Pregnancies inthe Military Health System.

To determine if universal access to care for military beneficiaries improves timing of presentation to prenatal care (PNC) in adolescent and young adult (AYA) pregnancies, improving maternal and neonatal outcomes. Retrospective descriptive cohort study, which assessed PNC initiation in eligible military beneficiaries: dependent daughters, active-duty women, and active-duty spouses aged 13 to 26 between January 2015 and December 2019, and subsequent adverse maternal and neonatal outcomes. The cohort included 4,557 eligible pregnancies and 4,044 mothers aged 13 to 26. Late entry to PNC was not associated with gestational diabetes, prolonged rupture of membranes, pregnancy loss, elective abortion, substance use, or premature labor. Younger age was significantly associated with substance use, elective abortion, and sexually transmitted infection. There were 2,107 eligible newborns. There was no significant difference in gestational age at birth, incidence of prematurity, birthweight percentile, or occurrence of a neonatal intensive care unit admission based on maternal age. In comparison to published national outcomes, there was a significantly smaller occurrence of preterm (5.3% vs. 9.57-10.23%, 95% CI, 4.4-6.4%), small for gestational age (5.2% vs. 10-13%, 95% CI, 4.3-6.2%), and large for gestational age (4.8% vs. 9%, 95% CI, 4.0-5.8%) births, but a higher occurrence of neonatal intensive care unit admissions (16.9% vs. 7.8-14.4%, 95% CI, 15.4-18.6%) in infants born to military beneficiaries. Our findings suggest that expanded universal access to health care may improve AYA pregnancy and delivery outcomes. Infants born to AYA military beneficiaries have improved neonatal outcomes compared to nationally published data. These results may correlate to improved maternal access within a free or low-cost healthcare system.

The effect of rural hospital closures on maternal and infant health.

To evaluate the effect of rural hospital closures on infant and maternal health outcomes. We used restricted National Vital Statistics System birth and linked birth and infant death data, merged with county-level hospital closures from the Sheps Center for the period 2005-2019. We used difference-in-difference and event study methods, employing new estimators that account for staggered treatment timing. Our key outcome variables were prenatal care initiation; birth outcomes (<2500 g; <1500 g; <37 weeks; <28 weeks; 5-min Apgar); delivery outcomes (cesarean, induction, hospital birth); and infant death (<1 year of birth; <=30 days of birth; <=7 days of birth; <= 1 day after birth). The analysis covered all births in the United States in rural counties (by rurality: all, most, moderately rural). We found evidence that fewer individuals delivered in their county of residence after a hospital closure, and this was most pronounced for residents of the most rural counties (29%-52% decline (p < 0.01) in the likelihood of delivering in their residence county). We found that hospital closures worsen prenatal, infant, and delivery outcomes for residents of moderately rural counties but improve those outcomes for those in the most rural counties. In moderately rural counties, low birth weight births increased by 10.4% (p < 0.01). We found suggestive evidence of decreased infant deaths in the most rural counties. This pattern of findings is consistent with closures leading residents of the most rural counties to seek care in a different county and residents of moderately rural counties to seek care at a different hospital in the same county. Loss of hospital care has meaningful effects on the rural populations; investigating rural counties in aggregate may miss nuanced differences in the effects on the margin of rurality.

SAT132 Isolated Elevated Hemoglobin A1c At Early Diagnosis Of Gestational Diabetes Does Not Predict Need For Hypoglycemic Agents

Abstract Disclosure: E.S. Markovic: None. J. Rios: None. S. Scarpelli-Shchur: None. E. Kaplowitz: None. T.S. Strauss: None. L. Brustman: None. Introduction: ACOG recommends universal screening for gestational diabetes (GDM) at 24 - 28 weeks, as well as screening at the initiation of prenatal care for patients with risk factors. While HbA1c ≥5.7% signifies impaired glucose regulation, data is limited regarding its prognostic utility in patients with early diagnosis of GDM (&amp;lt;24 weeks). We hypothesized that HbA1c &amp;gt;5.7% at diagnosis predicts worse disease as measured by need for hypoglycemic medication. We also compared neonatal outcomes between patients HbA1c &amp;gt; and &amp;lt; 5.7%. Methods: An IRB approved retrospective cohort study from 2016 - 2021 of patients in our Diabetes in Pregnancy Program diagnosed with GDM &amp;lt;24 weeks by Carpenter-Coustan criteria or fingerstick paneling. We compared those with HbA1c &amp;gt;5.7% to those with HbA1c &amp;lt;5.7% with regard to demographics, need for hypoglycemic medication in pregnancy and neonatal outcomes including birth weight, Apgar scores, hypoglycemia, respiratory distress, jaundice, stillbirth and NICU admission. Results: 113 out of 1,520 patients had early onset GDM with HbA1c drawn at time of diagnosis. HbA1c range 4.5 - 7.5% (median 5.5%). Gestational age at diagnosis range 6.4 - 23 weeks (median 15.6 weeks). 72 (64%) had a HbA1c &amp;lt;5.7% while 41 (36%) had a HbA1c ≥5.7%. Larger BMI (p&amp;lt;0.0001), higher fasting GTT (p&amp;lt;0.0001), larger number of abnormal GTT values (p=0.009), Hispanic ethnicity (p=0.003) or Black race (p=0.004), and hyperlipidemia (p=0.016) were significantly associated with HbA1c &amp;gt;5.7%. A greater proportion of patients with HbA1c ≥5.7% required hypoglycemic medication [37 (90%) vs. 51 (71%), p= 0.032]. Patients with HbA1c &amp;gt;5.7% were 3.9 times more likely to require hypoglycemic agents compared to patients with HbA1c &amp;lt;5.7% (p=0.042). The odds of receiving medication were 8.5 times greater for each percent increase in HbA1c (p=0.004). After adjusting for confounders, HbA1c ≥5.7% at early GDM diagnosis was not significantly associated with increased likelihood of needing hypoglycemic agents (OR=3.4; p=0.304). Only fasting GTT was associated with needing hypoglycemic agents (OR=1.2; 95% CI: 1.0, 1.3; p=0.023). HbA1c &amp;gt;5.7% was associated with lower Apgar score at 1 minute (p=0.039) and earlier gestational age at delivery (p=0.009) but these were not significant after adjusting for confounders. Conclusion: The premise of our study was that HbA1c &amp;gt;5.7% in early diagnosed GDM would be associated with impaired glucose tolerance and therefore more significant disease. Counterintuitively, our data do not suggest this. An isolated HbA1c &amp;gt;5.7% was not predictive of the need for hypoglycemic agents or adverse neonatal outcomes. Future directions should include large prospective studies to clarify if HbA1c &amp;gt;5.7% is associated with more severe disease, adverse neonatal outcomes, and the development of type 2 diabetes. Presentation: Saturday, June 17, 2023

Health Disparities in the Use of Primary Cesarean Delivery among Asian American Women.

This study examined the health disparities in primary cesarean delivery (PCD) use among Asian American (AA) women and within AA subgroups. We examined 22 years of birth registry data from one diverse northeastern state in the United States, including singleton vertex live births between 24 and 44 weeks of gestation without congenital abnormalities. Multivariate logistic regression was used to test the association between PCD and race and ethnicity groups adjusting for maternal demographic and health behaviors, infant gender and birth weight, gestational age, initiation of prenatal care, and other risk factors. Among the eligible sample, 8.3% were AA. AAs had the highest rate of PCD (18%) among all racial and ethnic groups. However, extensive heterogeneity was found among the AA subgroups. After controlling for confounding variables, compared to non-Hispanic White women, Filipino, Asian Indian, and Other Asian subgroups had a higher risk for PCD (Adj OR = 1.40, 1.37, and 1.21, p < 0.001), while Japanese, Chinese, and Korean had a lower risk (Adj OR = 0.57, 0.83, and 0.90, p < 0.001), and Vietnamese had no significant difference in PCD use. Although AA as a single racial and ethnic group had higher prevalence of PCD, more studies are warrantied to address the disproportional distribution of health disparities in PCD use within AA subgroups.