33 - Who Receives Prenatal Myelomeningocele Repair? Longitudinal Demographic Insights from a Texas Fetal Intervention Program Using a Statewide Database

Publication Number: 4032.33

Samarchitha Magal, McGovern Medical School at the University of Texas Health Science Center at Houston, Houston, TX, United States; Cecilia Ganduglia Cazaban, UTHealth Houston School of Public Health, Houston, TX, United States; Sepideh Saroukhani, McGovern Medical School at the University of Texas Health Science Center at Houston, Houston, TX, United States; Ramesha Papanna, University of Texas at Houston, Houston, TX, United States; Suzanne M. Lopez, McGovern Medical School at the University of Texas Health Science Center at Houston, Houston, TX, United States

Background: Myelomeningocele (MMC), the most common open neural tube defect, occurs when the spinal cord fails to develop properly in utero. Prevalence in Texas is higher among Hispanic and advanced maternal age women. Prenatal MMC repair reduces long-term morbidity and is now the standard of care for eligible cases, but access may be limited by socioeconomic barriers as few centers specialize in this procedure. The Fetal Center at Children's Memorial Hermann (CMHH) has offered prenatal MMC repair since 2011; however, patient demographics have not been systematically compared to the statewide population at risk for fetal MMC.

Objective: To describe trends in disparities among women evaluated for prenatal MMC repair at the Fetal Center at CMHH between 2012-2023 using an all-payer database.

Design/Methods: This population-based retrospective cohort study was conducted under IRB approval from UTHealth Houston and CMHH. Maternal data were obtained from the Texas Health Care Information Collection (THCIC), a statewide database of de-identified inpatient, outpatient, and emergency department data. The CMHH cohort was identified using Current Procedural Terminology (CPT) codes for fetal or pelvic MRI and International Classification of Diseases (ICD)-9/10 codes for fetal MMC. The comparator cohort included females with liveborn infants with fetal MMC, identified using ICD-9/10 codes for fetal MMC and liveborn childbirth. Maternal demographics were collected, and socioeconomic status (SES) was estimated using the CDC Social Vulnerability Index (SVI) by county. Descriptive statistics were performed, per capita rates, and chi-squared tests of independence will be conducted to identify significant associations.

Results: A total of 293 patients with fetal MMC who underwent fetal/pelvic MRI at CMHH were identified. Compared to statewide cases, the CMHH cohort had lower proportions of Hispanic (31% vs 42%) and Medicaid-insured (32% vs 56%) patients and a higher proportion of privately insured patients (55% vs 37%). Most patients (81%) were from Texas, and SES by SVI showed a trend toward serving increasingly vulnerable populations over time. Further analysis of SES, demographic, and temporal trends is ongoing.

Conclusion(s): Despite increasing numbers of women evaluated for prenatal MMC repair, disparities persist. The CMHH cohort remains predominantly privately insured, with fewer Hispanic and Medicaid-insured patients compared to statewide cases. These findings highlight potential barriers to care, including insurance and travel, and inform efforts to ensure equitable access to this specialized intervention.

Distribution of Demographic Characteristics Among Patients, 2012-2023
Demographic characteristics of women evaluated at our Fetal Center for prenatal MMC repair and women who delivered a liveborn infant with MMC in the state of Texas between 2012-2023. SVI is divided into four quartiles, grading counties from lowest (Q1) to highest (Q4) vulnerability; socioeconomic status (SES) is estimated from SVI, with lower vulnerability (Q1) approximating higher SES. 25 patients from the CMHH cohort and 20 patients from the statewide cohort were excluded from SVI calculations due to missing county information. The percentages in parentheses report the proportion of that value compared to the total number of patients in that column.

Distribution of Race and Ethnicity By Year for Patients Evaluated for Prenatal Myelomeningocele Repair at the Fetal Center at Children's Memorial Hermann, 2012-2023
Distribution of race and ethnicity of patients evaluated at our fetal center for prenatal MMC repair between 2012-2023. Race and ethnicity are grouped in mutually exclusive groups (Hispanic of any race grouped as Hispanic, White Non-Hispanic as White, Black Non-Hispanic as Black, American Indian/Eskimo/Aleut as Native). Number of patients and heterogeneity of race/ethnicity per year increases as time goes on.

Distribution of Social Vulnerability Index by Socioeconomic Status for Patients Evaluated for Prenatal Myelomeningocele Repair at the Fetal Center at Children's Memorial Hermann, 2012-2023
Box-and-whisker plot showing distribution by year of socioeconomic social vulnerability index (SVI) of patients evaluated at our fetal center for prenatal MMC repair between 2012-2023. SVI is estimated by patient county, 25 patients were excluded due to missing county information. Boxes indicate the 25th-75th percentile (interquartile range), horizontal lines represent the median, diamonds represents the mean, and whiskers show the range of non-outlier values. Increased spread of SVI and a trend towards higher vulnerability (lower socioeconomic status) is noted as time goes on.