(120) Association between distance to fetal treatment center and abortion consideration among people with fetal myelomeningocele

Objective: The relationship between geographic distance and abortion for individuals with fetal myelomeningocele (fMMC) has not yet been elucidated. Thus, we aimed to evaluate the association between distance traveled to fetal treatment center (FTC) and consideration of abortion among patients with fMMC.
 

Study Design: We performed a retrospective cohort analysis of all fMMC consultations at a FTC in Illinois from 2018-2023. The exposure was distance traveled to FTC, collected as miles from patient’s zip code of residence to FTC. Distance was analyzed categorically, dichotomized based on median value, and continuously. The primary outcome was abortion consideration, ascertained by a nurse during FTC intake. Bivariate and multivariate log-binomial regression analyses were performed, treating distance traveled as an interaction factor with state of residence. P< 0.05 indicated statistical significance.
 

Results: 100 patients were available for analysis. Median distance traveled was 62.2 miles (range 1.2-928.2). On bivariate analysis, people traveling below the median distance were more likely to identify as Latinx, reside within Illinois, and present at an earlier gestational age when compared with those traveling above the median distance (Table). On regression modeling, when compared with individuals living below the median distance and outside Illinois, both living above the median distance and outside Illinois (aRR 0.36, 95% CI 0.17-0.75) and within Illinois (aRR 0.40, 95% CI 0.18-0.79) were independently associated with a lower risk of considering abortion after controlling for maternal ethnicity. On regression modeling after controlling for ethnicity, for every mile traveled, the risk of considering abortion decreased by 1% (aRR 0.99, 95% CI 0.98-1, p = 0.003 for in-state, p = 0.01 for out-of-state).
 

Conclusion: Increased distance traveled is associated with lower risk of abortion consideration prior to presenting to an FTC for fMMC consultation. These data emphasize the nuanced relationship between fetal diagnosis and abortion and importance of providing comprehensive reproductive counseling to FTC patients.