2023 ACMG Annual Clinical Genetics Meeting Digital Edition: Poster Gallery-Social determinants of health and genetic testing in intrauterine fetal demise

Pdf Summary

Intrauterine fetal demise, or stillbirth, is a common adverse pregnancy outcome that affects about 1 in 175 pregnancies in the United States. While medical risk factors for stillbirth have been identified, there is growing evidence that social determinants of health (SDOH) such as race, income, education, and access to prenatal care play a role in stillbirth rates. This study aimed to examine the impact of these social, racial, and economic factors on post-delivery evaluation among cases of stillbirth in a large urban care center.<br /><br />The study analyzed data from stillbirth deliveries at two sites within a tertiary care center in Houston, Texas from 2016 to 2021. The study found that racial disparities extend beyond the occurrence of stillbirth and also impact the evaluation performed thereafter, particularly regarding diagnostic genetic testing. Hispanic and non-Hispanic black women were less likely to receive diagnostic genetic testing compared to non-Hispanic white women.<br /><br />There were no significant differences in placental pathology rates or autopsy rates based on race and ethnicity. However, the lack of differences observed with autopsy may be due to low overall uptake of fetal autopsy. Insurance status did influence receipt of genetic testing, with Hispanic and non-Hispanic black women more likely to have federal insurance, which may impact their uptake of diagnostic genetic testing.<br /><br />The study highlights the need for further research into the influence of social determinants of health on other aspects of stillbirth evaluation, such as infectious studies, urine drug screening, and laboratory evaluation. Additionally, future analysis should differentiate between differences in testing uptake based on patient declination versus lack of provider offer.<br /><br />Overall, the study suggests that social, racial, and economic factors have an impact on the evaluation performed after stillbirth. More research is needed to understand the reasons behind these disparities and develop interventions to ensure equitable access to comprehensive evaluations for all women and families affected by stillbirth.

Asset Subtitle

Presenting Author - Lena A. Shay, MD; Co-Author - Sarah Tounsi, MD; Co-Author - April D. Adams, MD, MS, FACMG, FACOG;

Meta Tag

Fetal Pathology

Genetic Testing

Maternal Serum Screening

Noninvasive prenatal screening (NIPS)

Pathology

Prenatal Diagnosis

Co-Author Sarah Tounsi, MD

Co-Author April D. Adams, MD, MS, FACMG, FACOG

Presenting Author Lena A. Shay, MD

Keywords

stillbirth

adverse pregnancy outcome

social determinants of health

racial disparities

diagnostic genetic testing

Hispanic women

non-Hispanic black women

non-Hispanic white women

insurance status

equitable access