P3D386: When Home Is Where They Send You: Impact of Transfer of Care at >20 Weeks Gestation on Maternal and Neonatal Outcomes

Background: No literature currently exists examining the phenomenon of mid-late pregnancy transfer of care (TOC) on maternal and neonatal outcomes in the U.S. There are limited, generalized studies illustrating that maternal stress is associated with both preterm birth and low birth weight. Mid-late pregnancy transfer of care may result in stress and can potentially cause difficulty re-establishing medical care. Studies do demonstrate that no prenatal care (one visit or less) versus sufficient prenatal care results in higher rates of preterm birth, longer admission, and lower birth weights. Within the transient military population, it is crucial to understand the implications of TOC during pregnancy.

Study

Aims: (1) determine the incidence and timing of transfer of care (TOC) at ≥20-weeks gestation within the Brooke Army Medical Center (BAMC) population. (2) Compare the rate of adverse maternal and neonatal outcomes for this population to baseline data.

Methods: Retrospective cohort review of all pregnant military-affiliated individuals who experienced TOC at ≥20 weeks and resultant live births delivered at BAMC between January 2017-December 2021. Descriptive statistics were utilized to report incidence of maternal and neonatal variables and outcomes within the cohort. Local National Perinatal Information Center data was utilized for baseline comparison.

Results: Nine-hundred and twenty-six pregnant individuals transferred care at ≥ 20 weeks gestation, resulting in 939 live-births (12.9% of all births occurred after TOC). Median age at transfer was 30 weeks gestation (Figure 1). Ninety-nine patients (10.7%) had at least 1 incomplete lab at time of birth admission, most commonly glucose tolerance testing. Mental health diagnoses were present in 174 patients (18.9%). The rate of postpartum hemorrhage was 3%, lower than hospital baseline 4.1% (Table 1). Twenty patients transferred care within a week of delivery. Primary C-section was mode of delivery for 184 individuals (19.4%) lower than hospital baseline of 21.8%. Infants delivered at a mean gestational age of 38.8 weeks (± 1.4 weeks) and birthweight 3332 grams (± 502.5 grams). Only 5.3% individuals delivered preterm. One hundred and twenty-eight neonates (13.6%) underwent sepsis evaluation with antibiotic coverage. Of these, antibiotic exposure mean was 3.2 days (± 1.9 days) and 18 neonates (1.9%) received ≥ 4 days of antibiotics. Three neonates were diagnosed with culture proven sepsis, an early onset sepsis rate of 3.2/1000 (CDC rate 0.5/1000). Ninety-seven neonates (10.3%) required NICU admission, with average length of stay 2.7 days.

Conclusion: Mid-late pregnancy TOC is a common occurrence for military affiliated women. This single-center study did not reveal many significant differences in maternal and neonatal outcomes after mid-late pregnancy TOC. Further examination of maternal and neonatal outcomes following TOC across the military health system and comparison to baseline population is crucial to better ensure optimal provision of care for this military-unique population.