285 - Disparities in Antenatal Counseling for Mothers of Periviable Infants

Poster Number: 285
Publication Number: 285.1951

Background: There are racial and ethnic disparities in the resuscitation of infants born in the periviable period. Few studies have investigated disparities in the presence of an antenatal consultation with neonatology, a key component of periviable care delivery.

Objective: To assess relationships between sociodemographic and clinical factors and antenatal neonatology consultation and parental decision-making surrounding resuscitation in the periviable period.

Design/Methods: This is a retrospective review of mothers whose liveborn infants were born in the periviable period (22+0 to 24+6 weeks) at one of five regional locations from January 1, 2015 – December 31, 2021. Mothers whose infants were not offered resuscitation were excluded. Outcomes included receipt of antenatal neonatology consultation (yes/no) and parental preference for resuscitation. Exposures were sociodemographic and clinical characteristics, including maternal race, ethnicity, language, age, insurance, fertility treatment, prenatal care, infant gestational age, and site of care. Links between outcome and exposure variables were analyzed with chi-square tests, independent t-tests, and Fisher’s exact tests, as applicable.

Results: A total of 232 infants were identified during the study period; 194 infants met inclusion criteria. The identified maternal cohort was mostly non-Hispanic White (52% White, 97% non-Hispanic) and English-speaking (94%) with a median maternal age of 28 years and median infant gestational age of 24+0 weeks (Table 1). Half the mothers had Medicaid insurance. Most patients received a neonatology consultation prior to delivery (88%) with median time from admission to consult of 3.5h and median time from consult to birth of 68h. Most families preferred full resuscitation in the delivery room (77%). Maternal race and insurance payer type were significantly associated with neonatology consultation: 94% of White mothers vs. 80% of Black mothers received a neonatology consult (p=0.005), and 95% of mothers with commercial insurance vs. 80% of mothers with Medicaid insurance received a consult (p=0.009). When stratified by delivery site, the disparity persisted. Maternal race and insurance were not associated with timing of neonatology consultation or with resuscitation preference.

Conclusion(s): In this regional assessment of periviable births, perinatal care delivery differed by maternal race and payer type. Black mothers and those with Medicaid insurance were less likely to receive a neonatal consultation. Further work is needed to assess drivers of inequitable care delivery in the hospital setting for this vulnerable population.