37 The shadow of social determinants: Geographic obstetric disparities predict regional COVID-19 burden

Abstract

s 36-43 36 Racially inequitable definitions of anemia perpetuate disparities in maternal outcomes: time to change Rebecca F. Hamm, Eileen Y. Wang, Lisa D. Levine, Sindhu K. Srinivas Maternal and Child Health Research Center, Department of Obstetrics & Gynecology, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA OBJECTIVE: When defining anemia in pregnancy, ACOG recommends lower hemoglobin (Hb) cutoffs for Black vs. non-Black women (3rd trimester Hb<10.2g/dL in Black women; <11g/dL in non-Black women). We aimed to determine the impact of this definition on Hb at delivery and blood transfusion rates. STUDY DESIGN: We performed a prospective cohort study of women with antepartum Hb<11g/dL delivering at our institution from 2018-2019. During the study period, treatment of anemia with iron supplementation occurred per race-based recommendations. For example, using these definitions, Hb1⁄410.3g/dL in a non-Black woman warranted iron, while the same Hb in a Black woman did not. Antepartum anemia was categorized by severity (Hb<10.2g/dL; 10.2-11.0g/dL) and analyses stratified by self-reported race (Black; non-Black). RESULTS: The Figure depicts the cohort (n1⁄41455) by antepartum Hb and race. 51.9% of Black women had an antepartum Hb 10.2-11.0g/ dL; unlike the rest of the cohort, these women did not meet the racebased anemia cutoff for treatment. As a result, 41.0% of Black women with antepartum Hb 10.2-11.0g/dL remained <11g/dL at delivery compared to 26.4% of non-Black women with antepartum Hb 10.2-11.0g/dL (p<0.001). This equates to 75% increased odds of presenting for delivery with Hb<11.0 for Black vs. non-Black women even when controlling for age and parity (aOR 1.75 95%CI [1.31-2.32]). Importantly, the transfusion rate was the same among Black and non-Black women who presented for delivery with Hb<11g/dL (8.4% vs. 9.4%, p1⁄40.76), and all women with Hb<11g/ dL at delivery were at 3 times higher odds of transfusion when compared to those 11g/dL (aOR 3.43 95%CI[2.09-5.65]). CONCLUSION: Hb<11g/dL at delivery, regardless of race, is a risk factor for transfusion, and Black women are more likely to present to delivery with Hb<11g/dL due to differential treatment of anemia by race. If these Black women had been treated, 1 in 7 may have Hb 11g/dL by delivery, significantly decreasing transfusion risk. Race-based treatment thresholds need to change to eradicate systemic inequities that perpetuate disparities in maternal morbidity. Supplem 37 The shadow of social determinants: Geographic obstetric disparities predict regional COVID-19 burden Ponnila S. Marinescu, Courtney Olson-Chen, J. Christopher Glantz, Elaine L. Hill, Stefanie J. Hollenbach University of Rochester Medical Center, Rochester, NY, University of Rochester, Rochester, NY OBJECTIVE: Similar to obstetrics outcomes, rates of SARS-CoV-2 (COVID-19) infection are not homogeneously distributed among populations; risk factors accumulate in discrete locations. Our objective was to investigate the geographical correlation between pre-COVID-19 regional preterm birth (PTB) disparities and subsequent COVID-19 disease burden. STUDY DESIGN: This is a retrospective, ecological cohort study of a regional birth database from 2004-2018 merged with publicly available community resource data. COVID-19 rates from 2020 were used to allocate zip codes to “low,” “moderate”, and “high” groups as defined by median COVID-19 diagnosis rates. These COVID-19 cohorts were then associated with poverty and educational attainment data from the US Census Bureau. The dataset was analyzed for a primary outcome of PTB using ANOVA. Geographic information system (GIS) mapping was used to visualize PTB rates and COVID19 disease rates by zip code. RESULTS: 123,909 births within 38 zip codes were included. The median COVID-19 rate was 616.5 (per 100K). Historical community prevalence of PTB varied directly with 2020 cohort prevalence of COVID-19 and reached significance for PTB < 28 weeks and periviable births. Odds of PTB < 28 weeks were significantly higher in the “high” COVID-19 cohort compared to the “low” COVID 19 cohort (OR 3.27 (95% CI 2.42-4.42). COVID-19 prevalence was directly associated with number of individuals below poverty level and indirectly associated with median gross income and educational attainment (Figure 1). GIS mapping demonstrated ZIP code ent to FEBRUARY 2021 American Journal of Obstetrics & Gynecology S27 Oral Plenary Session II FELLOWS PLENARY ajog.org clustering in the urban center with highest rates of PTB <28 weeks overlapping with high COVID-19 disease burden (Figure 2). CONCLUSION: The geographic disparities in our regional preterm birth outcomes, ahead of the global pandemic, predicted community distribution of COVID-19 disease burden. These data should inspire socioeconomic policies supporting economic vibrancy in support of optimal health outcomes across all communities. 38 Daily vs. Intermittent Iron Therapy in Moderate Iron Deficient Pregnant Patients: A Randomized Non-inferiority Trial Raminder K. Khangura, Suzy Torti, Lia Tesfay, Frank Torti, ChiaLing Kuo, Erica Hammer, Stephanie Bakaysa, Winston Campbell Henry Ford Health System, Detroit, MI, University of Connecticut, Farmington, CT, Hartford Hospital, Hartford, CT, Hartford Healthcare, Hartford, CT, UCONN Health, University of Connecticut School of Medicine, Farmington, CT OBJECTIVE: Evaluate the hematological response of pregnant women to iron therapy in daily vs. intermittent treatment groups & evaluate gastrointestinal side effects & adherence to therapy. STUDY DESIGN: A pragmatic non-blinded randomized controlled non-inferiority trial performed at two medical sites. Pregnant women undergoing routine prenatal labs at 26-29 weeks gestation were approached about the study. Exclusion criteria were: diagnosed iron deficiency anemia < 26 weeks, already on iron supplementation, had a condition known to affect iron metabolism. Enrolled patients were randomized to supplemental iron daily or intermittently (every other day). The primary outcome was change in hemoglobin (Hgb) after treatment, with the non-inferiority margin set at 1 Standard Deviation (SD) ( 0.5 g/dL Hgb). Secondary outcomes were: differences in other hematological indices (hematocrit, mean corpuscular volume, serums transferrin receptor molecule, hepcidin, S28 American Journal of Obstetrics & Gynecology Supplement to FEBRUARY ferritin, calculated body iron store), gastrointestinal side effects & adherence. We assumed a mean increase of Hgb was 1 g/dL in the daily group. A 0.5 g/dL or more mean Hgb difference between groups was considered clinically significant. With a two sided, twosample t-test, to achieve a power of 90%, a of 0.05, 23 patients per group were needed. RESULTS: One hundred seventy-nine women were screened & 58 met study criteria, 29 were randomized to daily & 29 to intermittent iron groups. Twenty-two patients were analyzed in the daily group & 24 patients were analyzed in the intermittent group. Baseline characteristics were not different between groups (p >.05). Intermittent iron therapy was non-inferior to daily therapy, with a mean SD difference of 0.27 g/dL (95% CI: -0.33 to 0.89) (Figure). Changes in other hematological indices were not significant (Table). Women in the daily group had more nausea compared to intermittent group (p 1⁄4 0.040). Women in the intermittent group were not more adherent with therapy (p1⁄40.244). CONCLUSION: Intermittent iron therapy is non-inferior to daily iron therapy and is associated with less nausea but not increased adherence. 39 Influenza in pregnancy and severe maternal morbidity in the United States, 2000-2015 Timothy Wen, Brittany Arditi, Laura E. Riley, Mary E. D’Alton, Alexander M. Friedman, Kartik K. Venkatesh University of California, San Francisco, San Francisco, CA, Columbia University Irving Medical Center, New York, NY, Weill Cornell Medicine, New York, NY, The Ohio State University, Columbus, OH OBJECTIVE: Women with influenza in pregnancy have historically been shown to be at increased risk of adverse pregnancy outcomes, but contemporary U.S. data are lacking. Our objective was to