64 - The Changing Landscape of Planned Out-of-Hospital Births

Publication Number: 2061.64

Hadi Berbari, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States; Morgan E. Hill, Cincinnati Children's Hospital Medical Center, Loveland, OH, United States; Emily Miller, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States; Chunyan Liu, Cincinnati Children's Hospital, Cincinnati, OH, United States; Shelley Ehrlich, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States

Background: Planned out-of-hospital (OOH) births have increased in the United States, with a notable increase post the COVID-19 pandemic. The American College of Obstetricians and Gynecologists recommends strict selection criteria to minimize maternal and neonatal risks for OOH births: absence of preexisting maternal disease, cephalic presentation, and term singleton gestation. However, post-pandemic changes to maternal risk profile and neonatal outcomes in OOH births have not been studied.

Objective: To describe maternal sociodemographic and risk profiles in planned OOH births pre- vs. post-pandemic. To compare neonatal outcomes and receipt of recommended newborn screening and medications between in-hospital vs. planned OOH births in the pre- and post-pandemic eras.

Design/Methods: This retrospective cohort study includes pregnant individuals and their infants with planned OOH births in the Cincinnati region in two eras: pre-pandemic (1/1/2018-2/29/2020) and post-pandemic (4/1/2020-12/31/2023). Each OOH birth was matched 1:1 with comparable in-hospital controls from a cohort of 61755 births. Descriptive statistics were used to summarize the study cohort; propensity score analysis was used to evaluate the association between OOH birth and neonatal outcomes. All data was obtained from Ohio Department of Health birth certificate files.

Results: Planned OOH births doubled in the post-pandemic era (1.5% to 3%). Maternal Black or Asian race, Hispanic ethnicity, overweight or obese BMI, and completion of a high school, collegiate, or graduate degree increased in the post-pandemic era (Table 1). Maternal age, white race, number of prenatal visits, and underweight BMI decreased in the post-pandemic era. Neonatal characteristics and rates of adverse outcomes in OOH births were similar between eras (Table 2). OOH receipt of recommended newborn screening and medications was low in both eras. Fewer OOH infants received ocular prophylaxis in the post-pandemic era.

Compared with matched in-hospital births, OOH births did not have increased rates of adverse neonatal events in either era. OOH births were less likely to receive newborn medications compared to in-hospital births (Table 3).

Conclusion(s): OOH births in the study region doubled post-pandemic, reaching 3.0% of deliveries by 2023. This increase was associated with a shift in maternal sociodemographic and risk profile among those choosing OOH birth. Study infants born OOH had low absolute rates of adverse events that did not increase in the post-pandemic era or when compared to in-hospital births in our region.

Maternal Characteristics of the Planned OOH Cohort
Table 1 describes changes in maternal sociodemographic and risk profile between areas between January 1, 2018 - February 29, 2020 (pre-pandemic), and April 1, 2020 - December 31, 2023 (post-pandemic). Mothers who delivered during March of 2020 were excluded from this analysis as this was a transitional month during the pandemic.

Neonatal Characteristics, Outcomes, and Screenings for Planned OOH Cohort
Table 2 describes changes in neonatal characteristics, adverse events, and completion of routine screenings between January 1, 2018 - February 29, 2020 (pre-pandemic), and April 1, 2020 - December 31, 2023 (post-pandemic). Infants delivered during March of 2020 were excluded from this analysis as this was a transitional month during the pandemic.

Neonatal Outcomes for Planned OOH vs. In-Hospital Births (Matched Data)
Table 3 describes changes in adverse neonatal outcomes between OOH births and a matched in-hospital cohort between January 1, 2018 - February 29, 2020 (pre-pandemic), and April 1, 2020 - December 31, 2023 (post-pandemic). Infants delivered during March of 2020 were excluded from this analysis as this was a transitional month during the pandemic.