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Prematurity

Poster Session 4

(952) The association of sociodemographic differences with clinical management following a diagnosis of short cervix

Wednesday, February 14, 2024
1:00 PM – 2:30 PM  
Location: Prince George's Exhibit Hall CDE, Lower Atrium Level
Objective: To evaluate the association of sociodemographic (SD) factors and related systemic bias with variation in clinical management following diagnosis of a short cervix.

Study Design: Secondary analysis of a randomized trial in which singletons with a cervical length (CL) ≤ 20 mm were randomized to pessary vs. usual care. We assessed recommendations for vaginal progesterone (vag P), additional CL surveillance, pelvic rest, bedrest, and cerclage. Additional CL assessment was discouraged and cerclage allowed only for cervical dilation; activity modification and vag P were at provider discretion. SD factors were race and ethnicity, marital status, employment status, years of education, and type of insurance. Multivariable regression models examined the association between each SD factor and recommendation adjusting for other SD factors, CL at enrollment, clinical center, and treatment arm; odds ratios and 95% CI were determined.

Results:

Of the 446 patients (82% of 544 enrolled) with at least one post enrollment visit, 95.5% received vag P, 28% had additional CL assessment, 55.8% were on pelvic rest, 19.5% on activity restriction, and 7.4% had cerclage. The high rate of vag P usage precluded evaluation of association with SD factors. Non-Hispanic Black and Hispanic patients had lower odds of repeat CL assessment compared with Non-Hispanic White patients (aOR 0.47, 95% CI 0.24, 0.91; aOR 0.45, 95% CI 0.21, 0.99, respectively). No other SD factors were associated with repeat CL (Table 1). Patients with private insurance, but no other SD factor, had higher odds of pelvic rest recommendation (aOR 2.08, 95% CI 1.25, 3.45). None of the examined SD factors were associated with recommendations for bedrest or cerclage.

Conclusion: Non-Hispanic Black and Hispanic patients were less likely to have a repeat CL assessment following diagnosis of a short cervix and pelvic rest was more likely to be recommended to patients with private insurance. Variation in the frequency of these interventions raises questions about differences in intervention use based on race and ethnicity and insurance coverage.