Assessing Disparities in the Initiation of Prenatal Care in Women Who Present to the Emergency Department [ID 1050]

INTRODUCTION: Colloquially, we have seen emergency departments (EDs) become first-line prenatal care options for persons early in their pregnancy, due to lack of access. This leads us to question how prenatal care is performed in EDs, who utilizes the ED before initiating prenatal care, and how quickly and often this leads to long-term follow-up by an obstetrician. METHODS: This study was a retrospective cohort analysis examining persons who presented to an ED with a positive beta-hCG test between January 2, 2019, and December 31, 2019, without prior established obstetric care in their current pregnancy. RESULTS: Our study found notable differences between White (140 patients) and minority patients (Black, Hispanic, and Multiracial, ∼197 patients) populations who presented to the ED with pregnancy before the initiation of prenatal care. Minority patients were more likely to be on public insurance or uninsured ( P =.0148) and to establish care after 12 weeks of gestation (23.5% versus 11.6%, P =.0141). Minority patients were less likely to have an established obstetrician–gynecologist (44.4% versus 62.2%, P =.0013) or to have an obstetrician–gynecologist for their current pregnancy than White patients ( P =.0193). CONCLUSIONS/IMPLICATIONS: Although disparities are evident in the time taken to establish prenatal care, targeted interventions in the ED may help remedy this. Differences in insurance status between racial and ethnic groups may also be contributing to this disparity in the initiation of prenatal care. Therefore, providing education on options for pregnant women without insurance and who are underinsured at the time of ED visits may allow for smoother initiation.