(607) Impact of Health Disparities in Patients with Twin-to-Twin Transfusion Syndrome

Social determinants of health impact access to care for patients with complex pregnancies. This study aimed to determine whether patients diagnosed with twin-to-twin transfusion syndrome presented with more progressive disease as measured by Quintero stage (I-IV) at presentation for evaluation for intervention based on their type of insurance coverage.

Study Design: This retrospective cohort study included monochorionic-diamniotic pregnant patients diagnosed with twin-to-twin transfusion syndrome who underwent laser photocoagulation at our fetal center between 11/2011-5/2024. Patients were categorized based on their type of insurance coverage, defined as commercial/private insurance (Private) or The Children’s Health Insurance Program/Medicaid/No Insurance (Public). The primary outcome was the Quintero stage (I-IV) at the initial consultation for surgery. Secondary outcomes included gestational age at intervention, selective fetal growth restriction (sFGR), latency from referral to evaluation, location of evaluation, gestational age at delivery, and survival at 30 days. Patients without 30-day outcomes available were excluded.

Results: 484 patients underwent laser photocoagulation for TTTS at our center. Patients with public insurance were more likely to present with a higher Quintero stage than those with private insurance (3 [2,3], 3 [2,3], p=0.046). The public insurance group was also more likely to be White/Hispanic (45.7% v 19.5%, p< 0.001) or Black/Non-Hispanic (15.7% v 6.6%, p< 0.001), be evaluated as an inpatient (69% v 55%, p=0.002), have sFGR (47% v 36%, p=0.014) and have a higher gestational age at intervention (20.7[18.6,22.4] v 19.9[17.9,22.0], p=0.015). Latency from referral to evaluation and GA at delivery were similar, and we found no difference in survival at 30 days between groups.

Conclusion: Our study shows that social disparities exist in this population, and insurance status may be a surrogate of these inequities. However, long-term patient outcomes are equivalent with prompt, comprehensive care, aligning with the principle of distributive justice and the fair opportunity rule.