612 - Maternal Characteristics and the Social Determinants of Health in Prenatal vs Postnatal Myelomeningocele Repair

Publication Number: 3593.612

Amy R. Hardcastle, McGovern Medical School at the University of Texas Health Science Center at Houston, Pearland, TX, United States; Lydia S. Youmans, UTHealth, 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

Background: Myelomeningocele (MMC) is the most common and severe form of spina bifida. Clinical features include motor loss, sensory deficits, and dysfunction of the bowel and bladder. Two main approaches to surgical management of MMC include prenatal and postnatal repair. Compared to postnatal repair, prenatal repair is shown to improve motor outcomes and decrease hindbrain herniation, albeit with a higher maternal risk. While variables such as maternal BMI and gestational age are taken into consideration, the association between maternal characteristics and the social determinants of health (SDOH) with the modality of the repair method remains unclear.

Objective: This study aims to explore maternal characteristics and SDOH to identify factors that may be barriers to care for pregnant mothers with a MMC fetus to optimize maternal and neonatal outcomes.

Design/Methods: A retrospective chart review was conducted on 348 charts from mothers and infants seen at Children's Memorial Hermann Hospital from 2011 to 2024. Subjects were categorized by having undergone prenatal or postnatal repair. The association of maternal characteristics and SDOH with modality of MMC repair methods was assessed using Chi-square or Fisher's exact test for categorical variables, and an independent sample t-test for continuous variables.

Results: In our preliminary analysis, compared with the postnatal group, mothers in the prenatal group were more likely to report English as their preferred language, identify themselves as White or non-Hispanic/Latino, have private insurance, and reside in a zip code with a higher median household income (all p< 0.01). In addition, our analysis revealed that mothers in the prenatal group were more likely to hold a higher educational degree, be employed, and have adequate social support (all p< 0.01).

Conclusion(s): The findings above support our hypothesis that the prenatal group mothers have fewer disadvantaged characteristics and SDOH than those in the postnatal group. Possible reasons for these differences could be the additional support needed by mothers to undergo prenatal repair or access to a hospital center that performs prenatal MMC repair. Our results suggest a potential need to recognize barriers to care and explore ways to address them, thereby reducing disparities in healthcare. This could optimize treatment options and outcomes for both mother and infant to best meet their needs.

Select Maternal Characteristics and Social Determinants of Health
1 Chi-square test for categorical variables