007. Sociodemographic Disparities as a Determinant of Prenatal vs Postnatal Surgical Myelomeningocele Repair

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Authors: Allie Harbert

Relatively few women undergo open maternal fetal surgery (OMFS) for myelomeningocele (MMC) despite the surgery’s known benefits of less neonatal morbidity and lower levels of required lifetime medical care. We examined demographic and SOCIOECONOMIC characteristics of women who were offered and elected for OMFS vs patients whose children underwent postnatal MMC repair to identify variables contributing to disparities between these populations.Methods: A retrospective case control study was performed on patients evaluated for OMFS for MMC at a single academic hospital from 2015-2020. Race/ethnicity, primary insurance type, zip code, and BMI were collected and compared by treatment received and eligibility status for OMFS. Prevalence odds ratios were used to test for associations between each independent variable and the two outcomes. Logistic regression models were used to determine significant predictors of OMFS eligibility and undergoing OMFS.
Of 96 women evaluated, 36 underwent OMFS for MMC, 40 received postnatal repair, and 20 either terminated the pregnancy or underwent treatment elsewhere. 66 (68.8%) women were white, 14 (14.6%) Black, 13 (13.5%) Hispanic/Latinx, and 1 (1.0%) Asian. Among women who underwent OMFS for MMC, 27 (75.0%) were white, 2 (5.6%) Black, 4 (11.1%) Hispanic/Latinx, 1 (2.8%) Asian, and 2 (5.6%) identified as other or multiple races. Having private insurance or Tricare was associated with higher odds of being eligible for OMFS than of women with Medicaid or no insurance after controlling for race and income (3.87 95% CI 1.51-9.59).
Insurance status and BMI had significant associations between access to evaluation and proceeding with OMFS. Furthermore, this patient population was homogeneous and insufficiently represented the population affected by MMC. This raises concern that possible upstream barriers to care are preventing women from being considered for OMFS. Exploring sociodemographic characteristics, we identify variables that may limit access to highly specialized fetal surgical care.