Poster Session 2
Category: Clinical Obstetrics
Poster Session 2
Haley K. Sullivan, BS (she/her/hers)
PhD Candidate
Harvard Interfaculty Initiative in Health Policy
Cambridge, Massachusetts, United States
Anna D. Sinaiko, PhD
Assistant Professor of Health Economics and Policy
Harvard. T.H. Chan School of Public Health
Boston, Massachusetts, United States
Joanne C. Armstrong, MD
Vice President, Women's Health and Genomics
CVS Health
Wellesley, Massachusetts, United States
Kathe P. Fox, PhD
Board President
Health Care Cost Institute
Washington, District of Columbia, United States
Jessica L. Cohen, PhD
Bruce A. Beal, Robert L. Beal and Alexander S. Beal Associate Professor of Global Health
Harvard. T.H. Chan School of Public Health
Boston, Massachusetts, United States
Mark A. Clapp, MD, MPH (he/him/his)
Physician Investigator
Department of Obstetrics and Gynecology, Mass General Brigham
Boston, Massachusetts, United States
To analyze antenatal fetal surveillance (AFS) among live and stillbirths in a US cohort and describe variation in AFS use for pregnancies with and without indications for testing.
Study Design:
This study analyzed births from the Health Care Cost Institute (HCCI) commercial health insurance claims. AFS tests were captured with Current Procedural Terminology (CPT) codes for nonstress tests, biophysical profiles, and Doppler artery velocimetry. We analyzed AFS use in pregnancies that delivered at 32 weeks of gestation or later by AFS-indicated or AFS-not-indicated pregnancies and by birth outcome (stillbirth or live birth). “AFS-indicated” was defined by ICD-10 codes corresponding to conditions included in the ACOG guidelines on outpatient fetal surveillance.
Results:
We identified 2,792,701 live and stillbirths among 2,508,195 people. Pregnancies identified with indications for AFS had a significantly higher stillbirth rate than those without indications (7.94 vs. 4.88 stillbirths per 1000 births; p< 0.01). 62% of all pregnancies had ≥1 indication for AFS, and 59% of the sample had ≥1 AFS procedure. The distribution of indications for AFS is shown in Figure 1. Among pregnancies that were delivered ≥32 weeks, AFS-indicated pregnancies were substantially more likely to have AFS than AFS-not-indicated pregnancies (65.0 vs 46.5%, p< 0.001). Among AFS-indicated pregnancies, those that ended in stillbirth were less likely to have had AFS than those that ended in live birth (65.5 vs 72.6%, p< 0.001; Figure 2). A similar pattern was observed among AFS-not-indicated pregnancies (31.9 vs 38.0%, p< 0.001). 27.8% of AFS-indicated pregnancies did not receive any AFS.
Conclusion:
AFS use was common and associated with lower stillbirth rates in a large US cohort. Nearly 3 in 10 pregnancies with indications did not receive AFS. Further investigation is needed into barriers to receiving guideline-based care and to inform the design of future efforts improve care quality and reduce stillbirth rates in the US.