S1638 Disparities in Prenatal Care and Specialist Involvement Among Pregnant Individuals With Inflammatory Bowel Disease in Rural Versus Urban Settings

Introduction: Disparities in healthcare utilization between rural and urban populations are well-documented. However, limited data exist on whether these disparities are heightened among pregnant individuals with inflammatory bowel disease (IBD). The aim of this study was to compare prenatal care adequacy, ultrasound utilization, and gastroenterologist involvement among rural and urban individuals with IBD from preconception through postpartum. Methods: We conducted a population-based retrospective cohort study of individuals aged 18–50 with a confirmed diagnosis of IBD and a singleton pregnancy between April 1, 2003, and April 1, 2018, in Ontario, Canada. The primary outcome of healthcare utilization from preconception to postpartum has been reported elsewhere. This analysis focuses on secondary outcomes, including prenatal care adequacy—measured by the Revised-Graduated Prenatal Care Utilization Index (R-GINDEX)—as well as ultrasound utilization and gastroenterologist involvement, comparing rural and urban pregnant individuals with IBD. Multivariable negative-binomial regression was used to report adjusted incidence rate ratios (aIRR) with 95% confidence intervals (95% CI). Results: 8880 pregnancies were included (11.4% rural, 88.6% urban). There was no significant difference in receipt of adequate prenatal care (33.5% rural vs 35.1% urban; P = 0.30), although rural patients experienced a longer time to first prenatal visit (79 vs 76 days; P < 0.001). Rural residents also had significantly lower rates of prenatal ultrasounds (aIRR 0.88, 95% CI 0.84–0.92; P < 0.001) and were less likely to have at least one gastroenterology visit during preconception (53.5% vs 60.8%; P < 0.001), pregnancy (48.2% vs 53.8%; P = 0.002), and postpartum (51.6% vs 56.8%; P = 0.001) periods. Rural individuals also had fewer total gastroenterology visits across all periods, including preconception (aIRR 0.89; 95% CI, 0.81–0.97), pregnancy (aIRR 0.89; 95% CI, 0.80–0.99), and postpartum (aIRR 0.89; 95% CI, 0.82–0.98). Conclusion: This study demonstrates that pregnant individuals with IBD in rural areas experience delayed initiation of prenatal care, lower prenatal ultrasound utilization, and reduced gastroenterologist involvement throughout the perinatal period, highlighting the need for targeted interventions to ensure equitable care during pregnancy.