Abstract P208: The Differential Impact Of Residential Segregation On Gestational Hypertension Development Among Minority Women

Introduction: Higher levels of residential segregation have been associated with poorer cardiometabolic health profiles among women. Still, it remains unclear whether segregation may differentially impact the development of gestational hypertension (gHTN) among an ethnically-diverse cohort of pregnant women. We used birth record data from 2003-2009 and data from the 2000 US Census to determine whether racial and economic segregation are associated with gHTN among a diverse cohort of child-bearing women in the greater Philadelphia area. Methods: We quantified racial and economic segregation using sociodemographic data from the US Census and the local Getis-Ord (Gi*) spatial statistic. The Gi* produces a spatially-weighted z-score for each census tract reflecting the degree of clustering of racially-similar neighborhoods in an area relative to the surrounding Philadelphia region. We categorized each type of segregation as low (Gi*<0), moderate (Gi*0-1.96), or high (Gi*>1.96), and assigned these to each woman by her census tract of residence. Gestational hypertension was defined in the birth record data as the development of pregnancy-induced hypertension or preeclampsia. We used hierarchical generalized linear mixed effect models to obtain risk ratios and differences (per 1000 women) for the relationships between each form of residential segregation and gHTN. All models were stratified by maternal race/ethnicity, and sequentially adjusted for maternal sociodemographics, health behaviors, medical histories, and neighborhood-level characteristics. Results: Our sample consisted of 220,897 Non-Hispanic (NH) Black (26%), NH White (64%), and Hispanic (10%) women, of whom 4% developed gHTN. However, a much greater proportion of NH Black women both developed gHTN and lived in high segregation neighborhoods compared to NH Whites and Hispanics. After adjustment, NH Black women in moderate and high economic segregation areas had 16% higher risk (RR=1.16, 95% CI: 1.03-1.31) and 23% higher risk (RR=1.23, 95% CI: 1.08-1.39) of gHTN, respectively, compared to NH Black women living in low segregation areas. NH Black women in highly racially segregated neighborhoods saw an additional 9 cases of gHTN (per 1000 women) compared to NH Black women living in more racially integrated neighborhoods (RD=8.47, 95% CI: 3.14-13.80). Among NH White and Hispanic women, economic segregation was not associated with gHTN, and only marginally significant findings were observed for racial segregation. Conclusions: In our diverse sample of child-bearing women from the greater Philadelphia area, higher levels of racial and economic segregation were associated with greater risk of gHTN among NH Black women. Future work should seek to delineate the specific pathways by which neighborhoods differentially impact individual level cardiovascular health based upon race.

The course of pregnancy, delivery and the condition of newborn in women with uterus scar after previous cesar section

The objective: Analysis of pregnancy, delivery and the condition of newborns in women with uterus scar after previous Cesarean section. Materials and methods. Observations and retrospective analysis of individual maps of pregnant women, birth record and condition of newborns in 180 women with uterus scar after previous Cesarean section from 2014-2019. Results. It was found that women in I group had no history of miscarriage, and in II group this indicator was 6.7%. We were determined that the threat of early pregnancy was observed twice often in II group as in I group. Failure uterus scar during pregnancy was diagnosing in 21.1% of women of I group against 18.9% of women of II group, as well as during childbirth in 10% of women of II group against none of women of I group. In addition, 76.7% of women of I group were born by vaginal delivery against 24.4% of women of II group. In addition, 10% of newborns in women of I group on the Apgar scale were rated 6-7 points against 65.5% in a state of varying degrees of hypoxia in women of II group. Conclusion. Pregnancy and childbirth in women with uterus scar after previous Cesarean section were accompanying by complications of fetal and neonatal disorders. More pronounced changes were observing during pregnancy, delivery and changes in the condition of newborns in women of II group against with women of I group, which can be explaining by better pre-pregnancy preparation of women of I group and better monitoring during pregnancy. Keywords: сesarean section, pre-pregnancy preparation of women, the condition of newborns.

Classification of Medicaid Coverage on Birth Records in Wisconsin, 2011-2012

Objectives: In 2011, Wisconsin introduced the 2003 Revision of the US Standard Certificate of Live Birth, which includes a variable for principal payer. This variable could help in estimating Medicaid coverage for delivery services, but its accuracy in most states is not known. Our objective was to validate Medicaid payer classification on Wisconsin birth records. Methods: We linked 128 141 Wisconsin birth records (2011-2012 calendar years) to 54 600 Medicaid claims. Using claims as the gold standard, we measured the payer variable’s validity (sensitivity, specificity, positive predictive value [PPV], negative predictive value [NPV]) overall and by maternal age, race/ethnicity, education, facility delivery volume, and the Medicaid proportion of facility delivery volume. Multivariable log-binomial regression tested the association between each characteristic and payer misclassification among Medicaid-paid births. Results: Of 128 141 birth records, 50 652 (39.5%) indicated Medicaid as the principal payer and 54 600 (42.6%) linked to a Medicaid claim. The birth record misclassified 10 007 of 54 600 (18.3%) Medicaid-paid births as non-Medicaid and 6059 of 73 541 (8.2%) non-Medicaid births as Medicaid-paid. The payer variable was less sensitive (81.7%) than specific (91.8%), and PPV and NPV were similar (∼88%). Sensitivity was highest among mothers who were Hispanic, had no high school diploma, or delivered in Medicaid-majority delivery facilities. Maternal age ≥40, maternal education >high school, and delivering in a non–Medicaid-majority delivery facility were positively associated with payer misclassification among Medicaid-paid births. Conclusion: Differential misclassification of principal payer in the birth record may bias risk surveillance of Medicaid deliveries.

3049 Prenatal care as a protective factor for preterm birth and smoking during pregnancy in nulliparous patients: a propensity score analysis

OBJECTIVES/SPECIFIC AIMS: Preterm birth rates have been rising in the United States, and reducing preterm birth is a high-priority clinical and public health concern. There are no existing strategies to reduce preterm birth in nulliparous individuals. The present study aims to evaluate prenatal care as a protective factor for preterm birth in this population. METHODS/STUDY POPULATION: Missouri birth record data for child birth years 1993-2016 were used to create a sample of 325,088 singleton births to nulliparous women, themselves born in MO 1975-1985. Logistic regressions, stratified by maternal race (White, African-American, Asian, American Indian/Alaskan Native, Other), were used to predict preterm birth (< 37 weeks gestational age) as a function of 1) initiation of prenatal care of by end of first trimester and 2) Adequacy of Prenatal Care Utilization Index, with sociodemographic covariates of child birth year, maternal age, highest educational level, and marital status (four level variable, including married yes/no, and partner named on birth record, yes/no). Subsequent analyses will use this logistic regression to create a propensity score predicting smoking during pregnancy using birth record parental sociodemographic characteristics, stratified by maternal race. Primary analyses will focus on the role of prenatal care in predicting smoking during pregnancy and preterm birth risk within propensity score stratum. Secondary analyses will consider the role of other risk factors, including maternal pre-pregnancy BMI and maternal DUI history, on preterm birth risk. RESULTS/ANTICIPATED RESULTS: Preliminary logistic regressions predicting preterm birth were analyzed, stratified by maternal race. In White mothers, preterm birth prevalence was 8.2%, and risk was significantly increased by maternal age ≤ 15 and ≥ 31, being unmarried, and by receiving no prenatal care, yet unaffected by timing of prenatal care initiation. For African-American mothers, preterm birth prevalence was 11.9%, and risk was significantly increased by being unmarried and both by not initiating prenatal care by end of first trimester and receiving no prenatal care. Preliminary samples were too small for solid inferences for other races. Anticipated results are that after propensity score match, earlier initiation of prenatal care will show modest protective effect on preterm birth, but other characteristics such as maternal cigarette smoking during pregnancy and DUI status will show stronger effects on predicting preterm birth risk. DISCUSSION/SIGNIFICANCE OF IMPACT: By evaluating the role of prenatal care initiation and delivery on preterm birth, this work provides an evidence base for prenatal care schedules and for understanding the interplay of sociodemographics, healthcare delivery, and individual characteristics in the context of preterm birth risk and potentially reduce negative health outcomes.