(259) A comprehensive Early Pregnancy Access Clinic increases first trimester care in an underserved urban population

To assess the gestational age at which prenatal care (PNC) was initiated in an underserved urban population, and to compare the proportion of patients receiving first trimester PNC in a comprehensive Early Pregnancy Access Clinic (EPAC) versus traditional care model.

Study Design: This retrospective cohort study included patients initiating PNC at multiple faculty practice sites within a large urban medical center in the Bronx, NY from February to May 2023. Our EPAC offers multidisciplinary early pregnancy care at one location. During a single encounter, patients seen in EPAC are screened for medical comorbidities, have an ultrasound to confirm dating and viability, receive initial prenatal counseling/labs, and are scheduled for appropriate follow-up including routine obstetric care, high-risk obstetric care, or complex family planning care. Bivariate analyses comparing patient demographics and gestational age at entry into PNC by site of care were performed using Chi Square, Mann Whitney U, and t-tests. We used a multiple logistic regression model to estimate the adjusted odds ratio of attending PNC in the first trimester (< 14 weeks).

Results: Of 698 patients, 392 patients were seen in EPAC and 306 patients received routine PNC at other sites. Patients in both groups were largely non-White and publicly insured. EPAC patients initiated PNC earlier than patients at traditional PNC sites (10.6 vs. 14.0 weeks, p < 0.001). More EPAC patients were seen in the first trimester (73.0% vs. 49.7%, p < 0.001). After adjusting for age, BMI, race, and preferred language, EPAC patients had a 2.76 increased odds of initiating care in the first trimester (aOR 2.76, 95% CI 1.93-3.94).

Conclusion: Patients who initiated PNC at EPAC were more likely to be seen at an earlier gestational age. EPAC is a novel, patient-centered approach consolidating multiple facets of early pregnancy care into a single encounter and, thereby, increasing access in the first trimester for an underserved obstetric population.