Icon Legend

This session is not in your schedule.

This session is in your schedule. Click again to remove it.

Presentation Icons

Additional registration fee required

Faculty have requested this content not be shared on social media

CME Credit Offered

Poster Icons

Foundation Awardee

No Social Media

Back

Q&A

Fetus

Poster Session 4

(1182) Racial Disparities Impact on Perinatal Outcomes in Patients with Twin-Twin Transfusion Syndrome

Wednesday, February 14, 2024

1:00 PM – 2:30 PM

Location: Prince George's Exhibit Hall CDE, Lower Atrium Level

Primary & Presenting Author(s)

Kedeja V. Williams, MD

Johns Hopkins Hospital
CHARLOTTE, NC, United States

Coauthor(s)

MK

Michelle Kush, MD

Johns Hopkins Hospital
Baltimore, MD, United States
Jena L. Miller, MD (she/her/hers)

Assistant Professor
Johns Hopkins Center for Fetal Therapy
Baltimore, MD, United States
Arthur J. Vaught, MD

Johns Hopkins University School of Medicine
Baltimore, MD, United States
Andrew J. Satin, MD (he/him/his)

Professor and Director ( Chair)
Johns Hopkins University
Baltimore, MD, United States
CS

Camille Shantz, BS

Johns Hopkins
Montreal, QC, Canada
Elena R. Taylor (she/her/hers)

Johns Hopkins School of Medicine
Baltimore, MD, United States
Mara Rosner, MD, MPH

Assistant Professor
Johns Hopkins Center for Fetal Therapy
Baltimore, MD, United States
Ahmet A. Baschat, MD (he/him/his)

Director
Johns Hopkins Hospital
Baltimore, MD, United States

Objective: Racial disparities are a recognized factor for adverse outcomes in medicine. The impact of racial disparities on fetal therapy outcomes is largely unexplored. We sought to evaluate the impact of race on outcome in patients with Twin-Twin Transfusion Syndrome (TTTS) presenting for fetoscopic laser surgery (FLS).

Study Design: Single site secondary analysis of patients presenting for TTTS evaluation between July 2014 to March 2023. Groups were compared between 5 race categories (White, Black, Hispanic, Asian, and other) and then compared between White and nonwhite groups. Demographics, TTTS characteristics, and FLS outcomes were compared using Fisher’s exact Chi-square, Kruskal-Wallis and Mann-Whitney U-tests. Logistic regression was performed based on significance at univariate analysis.

Results: Of 408 patients with TTTS, 301 (73.8%) were White, 47 (11.5%) Black, 38 (9.3%) Hispanic, 20 (4.9%) Asian, and 2 (0.5%) were classified as other. Prior preterm birth was more common in Black patients (p =0.04). Nonwhite patients presented for evaluation later (20.1 [13 – 28.1] vs 18.6 [12.4-28.1] weeks, p=0.011) and at more advanced TTTS stages (p=0.001). Evaluation to laser interval was 0-1 day for all groups (NS). There was no difference in gestational age (GA) at delivery however perinatal survival was lower in nonwhite patients (160/214 (74.8%) vs 516/602 (85.4%), p< 0.001) due to lower double birth survival, 71/107 (66.4%) vs 243/301 (80.7%), p=0.007, and they were twice as likely to have no survivors at birth, 15/107 (14%) versus 21/301 (7%), p=0.01. The two greatest determinants of laser survival were insurance type and race (p< 0.001) [Figure].

Conclusion: Nonwhite patients with government insurance have the lowest perinatal survival after laser. Disparities significantly contribute to worse outcomes in patients with TTTS. The reason for these findings is likely complex and multifactorial, skewed by the nature of fetal therapy referral patterns, and demands further study.