(967) Race and Insurance Disparities in Partner Screening for Autosomal Recessive Conditions During Pregnancy

Objective: We aim to identify if race and insurance statuses of pregnant people and their partners impact decisions to undergo genetic carrier screening.

Study Design: Retrospective chart review was conducted on pregnant people receiving care at tertiary academic medical center from 6/1/2021-5/31/2024. Inclusion criteria were pregnant people (18+) with singleton pregnancies who tested positive for autosomal recessive conditions in 1^st or 2^nd trimesters and had genetic counseling. The primary outcome was comparison of uptake rates for genetic screening in partners of pregnant people with abnormal carrier screens by race and insurance status. Continuous variables were summarized with mean and standard deviations. Categorical variables were analyzed by Pearson’s Chi square test, summarized with % and frequencies.

Results:

Out of 62 pregnant people with abnormal genetic screens, 48% of partners opted for a genetic screen. Table 1 shows race and insurance statuses for pregnant people and partners. There was significant difference in racial makeup of patients (p< 0.0001) and partners (p< 0.0001) comparing tested and declined groups. There was no significant difference between insurance types of partners who tested vs. did not (p=0.422). More pregnant people identified as Hispanic/Latino (31%) and had Medicaid (63%), while more partners identified as White (31%) and had private insurance (42%). Couples with matching insurance were more likely to have both partners test vs. those with nonmatching insurance (p=0.0001). Couples with Medicaid had highest proportion of tested partners (77%). While there was no association between the insurance type of pregnant patients and whether their partners tested (p=0.306), there was an association between whether their partners tested and whether they were insured (p< 0.0001). 

Conclusion: Our results suggest a correlation between partner demographics and insurance and uptake rates of partner carrier testing. This shows disparities in uptake rates of genetic carrier screening, suggesting that SES factors may impact the decision for partner to test even with genetic testing access.