730 - “Standardized Periviability Counseling: Ensuring Equality and Improving Access”

Publication Number: 1707.730

Adrianna Jackson, University of Maryland Children's Hospital, Baltimore, MD, United States; Natalie Davis, University of Maryland School of Medicine, Baltimore, MD, United States; Francesca Okolie, University of Maryland Children's Hospital, Baltimore, MD, United States

Background: Periviable birth carries high morbidity and mortality risks, often worsened by racial and socioeconomic disparities. Counseling during this time is complex and influenced by provider communication, implicit bias, and inconsistent approaches.

Objective: To improve consistency and equity, our NICU and OB teams developed and implemented evidence-based, standardized periviability counseling guidelines in 2023. This study evaluates the impact of guideline implementation on counseling frequency and disparities.

Design/Methods: We performed a retrospective cohort study of periviable births (22 0/7–25 6/7 weeks) at a university-based tertiary care center from 2014–2024. Demographic and clinical variables were collected and compared pre- and post-guideline implementation. Primary outcomes included rates of any counseling and joint NICU/OB counseling. Analyses were conducted using SAS 9.4.

Results: Among 287 eligible patients (245 pre- and 42 post-implementation), there were no significant demographic differences between cohorts. Counseling rates improved from 80.8% to 95.2% (p < 0.0001), and joint counseling increased from 14.7% to 61.9% (p < 0.0001). Prior to implementation, counseling patterns varied by race, but post-implementation, counseling and joint counseling rates improved significantly for both Black and White patients (p < 0.0001).

Conclusion(s): Standardized periviability counseling improved both the rate and consistency of counseling, particularly joint counseling. These findings support adopting standardized, equity-based counseling practices at other tertiary care centers. Further studies are needed to assess long-term impacts on equity in counseling outcomes.

Overall Results
PAS Abstract Table.pdf