P1199 - Disparities in Prenatal Care and Specialist Involvement Among Pregnant Individuals With Inflammatory Bowel Disease in Rural Versus Urban Settings

Vithyaa Premjeyanth, MD¹, Parul Tandon, DO, PhD0¹, Vivian Huang, MD, MSc¹, Denice Feig, MD, MSc¹, Refik Saskin, MSc¹, Cynthia Maxwell, MBBS, MSc, FRACP¹, Deshayne Fell, MSc, PhD², Cynthia Seow, MBBS, MSc, FRACP³, John Snelgrove, MD, MSc¹, Geoffrey Nguyen, MD, PhD¹
1University of Toronto, Toronto, ON, Canada; 2University of Ottawa, Ottawa, ON, Canada; 3University of Calgary, Calgary, AB, Canada

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).

Discussion: 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.

Disclosures:
Vithyaa Premjeyanth indicated no relevant financial relationships.
Parul Tandon indicated no relevant financial relationships.
Vivian Huang indicated no relevant financial relationships.
Denice Feig indicated no relevant financial relationships.
Refik Saskin indicated no relevant financial relationships.
Cynthia Maxwell indicated no relevant financial relationships.
Deshayne Fell indicated no relevant financial relationships.
Cynthia Seow indicated no relevant financial relationships.
John Snelgrove indicated no relevant financial relationships.
Geoffrey Nguyen indicated no relevant financial relationships.

Vithyaa Premjeyanth, MD¹, Parul Tandon, DO, PhD0¹, Vivian Huang, MD, MSc¹, Denice Feig, MD, MSc¹, Refik Saskin, MSc¹, Cynthia Maxwell, MBBS, MSc, FRACP¹, Deshayne Fell, MSc, PhD², Cynthia Seow, MBBS, MSc, FRACP³, John Snelgrove, MD, MSc¹, Geoffrey Nguyen, MD, PhD¹. P1199 - Disparities in Prenatal Care and Specialist Involvement Among Pregnant Individuals With Inflammatory Bowel Disease in Rural Versus Urban Settings, ACG 2025 Annual Scientific Meeting Abstracts. Phoenix, AZ: American College of Gastroenterology.