(369) Assessing Racial Disparities in the Initiation of Prenatal Care in Women after Emergency Department Visits.

Objective: Colloquially, we have seen emergency departments (ED) become the first line of prenatal care for persons early in their pregnancy. Still, there is insufficient data on how this prenatal care is performed, who utilizes the ED prior to initiation of prenatal care, and how quickly and often this leads to long-term follow-up by an obstetrician for initiation of prenatal care. This study aimed to assess the demographics of women who presented with pregnancy for the first time in the emergency department before initiating prenatal care to identify demographics and risk factors associated with this presentation.

Study Design: A retrospective cohort analysis was conducted on women who presented at Fairview Hospital Emergency Department (ED) with a positive hCG test between January 2, 2019, and December 31, 2019, without prior established obstetric care in their current pregnancy.

Results: The analysis included 347 patients who presented to the ED before establishing obstetric care in their pregnancy, with 87% of patients seeking care for obstetric-related complaints during their ED visit. Our study found notable differences between non-Hispanic white (140 patients) and minority patients (Black, Hispanic, and Multiracial ~ 197 patients) populations, with minority patients being more likely to be on public insurance or uninsured (p = 0.0148) and to establish care after 12 weeks gestational age (23.5% vs 11.6%, p = 0.0141). Minority patients were less likely to have an established OB/GYN (44.4% vs 62.2%, p = 0.0013) or to have an OB/GYN for their current pregnancy than Non-Hispanic White patients (p =0.0193).

Conclusion: Although there are racial disparities evident in the time taken to establish prenatal care between minority to non-Hispanic white patients who present to the ED prior to establishing care, this study revealed how differences in insurance status between racial and ethnic groups may also be contributing to this disparity in the initiation of prenatal care.