The impact of socioeconomic factors on cerclage efficacy

Preterm birth (PTB) is a major public health burden. Transvaginal cerclage placement (TVCP) is a management option for cervical insufficiency, a cause of PTB. Socioeconomic factors contribute to PTB. Research evaluating the relationship of disparities to TVCP is limited. This study aims to determine the impact of socioeconomic factors (SEF) on TVCP efficacy. We also assessed the effects of SEF on mode of delivery, and birth weight. A retrospective cohort study from January 2008-November 2020 at an urban hospital was conducted. Of the 551 charts identified, 258 met Inclusion criteria: singleton pregnancies < 24 weeks gestational age (GA) presenting for history, ultrasound or physical exam indicated TVCP. We excluded patients with multifetal gestation, preterm premature rupture of membrane and TVCP > 24 weeks. Socioeconomic variables were assessed. Patient zip codes (ZC) were divided into high vs. low income, defined in relation to the median income (MI) in Florida ($53,267). The difference in latency and GA at delivery was compared. Categorical and continuous variables were analyzed by Chi square or Fisher’s exact tests, and t-tests or ANOVA respectively. Statistical significance was defined as p-value < 0.05. Of the 258 patients included, 52 (20.16%) were in the high income MI ZC and 206 (79.84%) in the low income MI ZC. Demographic characteristics were similar between groups except race. Black patients were more likely to live in the low ZC (p = 0.02) (Table 1). There was no significant difference between groups for indication for TVCP (p = 0.29), GA at TVCP (p = 0.17), tocolytic use (p = 0.80) or progesterone use (p = 0.46) (Table 1). No difference was found between the groups for GA at delivery, latency, delivery mode or birth weight (Table 2). Living in a low income ZC was not associated with a decrease in GA at delivery or shorter latency after TVCP (p-value >0.05). Given this finding, further studies should investigate the impact of ZC on access to TVCP.View Large Image Figure ViewerDownload Hi-res image Download (PPT)