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Abstract Details

Race Disparities in Pregnancy Care and Clinical Outcomes in Women with MS: a Diverse, Multicenter Cohort
Multiple Sclerosis
S31 - MS Clinical Decision Making and Special Populations (3:42 PM-3:54 PM)
002
Racial disparities persist in neurological and obstetrical care. Disparities in MS prevalence and outcomes reported for Black and Hispanic patients underscore the importance of evaluating for possible racial disparities in care during pregnancy.  
To compare pregnancy care and outcomes between Black, Hispanic, and White women with MS in a multicenter cohort.
Demographic and clinical data were extracted from the medical records of nine US MS centers for women with CIS/MS who became pregnant from 2010-2021. Each site provided data on similar numbers of Black/Hispanic and White women. Comparisons between racial groups of MS and pregnancy outcomes, socioeconomic factors, and data missingness were performed using Wilcoxon tests, ANOVA’s, and logistic regressions as appropriate to data type.
Overall, 294 live births were analyzed: 81 Black, 67 Hispanic, and 146 White women. Black and Hispanic women lived in areas of lower Child Opportunity Index (p<0.0001), while White women were more often employed, privately insured, and completed advanced degrees (p=0.003; p<0.0001; p<0.0001). Fewer Black and Hispanic women received a 14wk ultrasound (p=0.001); more Black women had emergency cesarean deliveries (p<0.03). Babies born to Black and Hispanic women had lower birthweights (p=0.04) and breastfed for shorter duration (p=0.004). Black and Hispanic women had higher median EDSS (B/H=1.5 W=1; p<0.0001) and higher annualized relapse rates at all time points (p<0.05 pre-conception). Finally, more Black women had missing medical record data for key metrics (p=0.046).
In this large multicenter cohort, Black and Hispanic women entered pregnancy with higher disability and less opportunity. Disparities in prenatal care and pregnancy outcomes have the potential to impact pregnancy experience, MS trajectories and intergenerational outcomes. Therefore, pregnancy represents an important opportunity for identifying structural access barriers and optimizing care in the neurological population. Further, inconsistencies in medical record documentation point to current methodological limitations in the study of health disparities.
Authors/Disclosures
Anne Marie Radzik
PRESENTER
Miss Radzik has received research support from University of California, San Fransisco.
Annika Anderson Annika Anderson has received personal compensation for serving as an employee of University of California, San Francisco.
Lilyana M. Amezcua, MD, FAAN (USC) Dr. Amezcua has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for serono. Dr. Amezcua has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Biogen. Dr. Amezcua has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Novartis. Dr. Amezcua has received personal compensation in the range of $10,000-$49,999 for serving on a Scientific Advisory or Data Safety Monitoring board for genentech. The institution of Dr. Amezcua has received research support from National MS Society. The institution of Dr. Amezcua has received research support from Genentech. The institution of Dr. Amezcua has received research support from Medday. The institution of Dr. Amezcua has received research support from Bristol Myers Squibb Foundation. The institution of Dr. Amezcua has received research support from NIH NINDS.
Sophie Ahmad, Other Ms. Ahmad has nothing to disclose.
Rachel Brandstadter, MD (University of Pennsylvania) Dr. Brandstadter has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Alexion.
Michelle Fabian, MD, FAAN (Mount Sinai Hospital) Dr. Fabian has nothing to disclose.
Edith Graham, MD (Northwestern University) Dr. Graham has nothing to disclose.
Sophia Eugenia Hodgkinson, MBBS Miss Hodgkinson has nothing to disclose.
Lindsay A. Horton, MD (UT Southwestern) Dr. Horton has nothing to disclose.
Dina Jacobs, MD (Hosp of Univ of PA/Dept of Neruo) Dr. Jacobs has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Biogen . Dr. Jacobs has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Genentech. Dr. Jacobs has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for EMD Serono. Dr. Jacobs has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Banner Life Sciences . Dr. Jacobs has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Bristol Myers Squibb. Dr. Jacobs has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Sanofi Genzyme. Dr. Jacobs has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Cycle Pharmaceuticals. Dr. Jacobs has received personal compensation in the range of $5,000-$9,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Horizon. Dr. Jacobs has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Novartis. Dr. Jacobs has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for EMD Serono. The institution of Dr. Jacobs has received research support from Biogen . The institution of Dr. Jacobs has received research support from Genentech .
Ilana B. Katz Sand, MD (Corinne Goldsmith Dickinson Center for MS) The institution of Dr. Katz Sand has received research support from National Multiple Sclerosis Society. The institution of Dr. Katz Sand has received research support from Hirschl Foundation. The institution of Dr. Katz Sand has received research support from National Institutes of Health. Dr. Katz Sand has received personal compensation in the range of $500-$4,999 for serving as a Conference presenter with American Academy of Neurology.
Amit Kohli, MD (Mount sinai hospital) Dr. Kohli has nothing to disclose.
Annette Okai, MD, FAAN (North Texas Institute of Neurology and Headache) Dr. Okai has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Alexion. Dr. Okai has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Biogen. Dr. Okai has received personal compensation in the range of $500-$4,999 for serving as a Consultant for BMS. Dr. Okai has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for EMD Serono. Dr. Okai has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Genentech. Dr. Okai has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Novartis. Dr. Okai has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Sanofi Genzyme. Dr. Okai has received personal compensation in the range of $5,000-$9,999 for serving on a Speakers Bureau for Alexion. Dr. Okai has received personal compensation in the range of $5,000-$9,999 for serving on a Speakers Bureau for Biogen. Dr. Okai has received personal compensation in the range of $5,000-$9,999 for serving on a Speakers Bureau for EMD SERONO . Dr. Okai has received personal compensation in the range of $5,000-$9,999 for serving on a Speakers Bureau for Sanofi Genzyme .
Monica R. McLemore, PhD,RN,Other (University of California, San Francisco) Dr. McLemore has received publishing royalties from a publication relating to health care.
Jasmin Patel, MD Dr. Patel has nothing to disclose.
Shane Poole (UCSF) Mr. Poole has nothing to disclose.
Sammita Satyanarayan, MD (Mount Sinai Medical Center) Dr. Satyanarayan has nothing to disclose.
Claire Riley, MD, FAAN (Columbia University Medical Center) Dr. Riley has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Genentech. Dr. Riley has received personal compensation in the range of $10,000-$49,999 for serving on a Scientific Advisory or Data Safety Monitoring board for EMD Serono. Dr. Riley has received personal compensation in the range of $10,000-$49,999 for serving on a Scientific Advisory or Data Safety Monitoring board for TG Therapeutics. Dr. Riley has received personal compensation in the range of $10,000-$49,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Horizon. Dr. Riley has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Novartis. Dr. Riley has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Viracta. Dr. Riley has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for TG Therapeutics.
Lauren Tardo, MD (UT Southwestern Medical Center) Dr. Tardo has received personal compensation in the range of $500-$4,999 for serving as a Consultant for EMD Serono. Dr. Tardo has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for NeurologyLive. Dr. Tardo has received personal compensation in the range of $500-$4,999 for serving as a Panel member with CanDoMS. Dr. Tardo has a non-compensated relationship as a Tardo with The MOG Project that is relevant to AAN interests or activities.
Elizabeth Verter, MD (Mount Sinai Hospital) Dr. Verter has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for EMD Serono. Dr. Verter has received personal compensation in the range of $50,000-$99,999 for serving as a Fellow with National MS Society.
Veronica Villacorta, Other (USC) Ms. Villacorta has received personal compensation for serving as an employee of USC.
Mitzi Joi Williams, MD, FAAN (Joi Life Wellness Group) Dr. Williams has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Biogen Idec. Dr. Williams has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Novartis Pharmaceuticals. Dr. Williams has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for EMD Serono. Dr. Williams has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Genentech. Dr. Williams has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Genzyme. Dr. Williams has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for TG Therapeutics. Dr. Williams has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Alexion. Dr. Williams has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Bristol Myers Squibb. Dr. Williams has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Horizon Therapeutics. Dr. Williams has received personal compensation in the range of $10,000-$49,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Genentech. Dr. Williams has received personal compensation in the range of $10,000-$49,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Novartis. Dr. Williams has received personal compensation in the range of $10,000-$49,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Biogen. Dr. Williams has received personal compensation in the range of $10,000-$49,999 for serving on a Scientific Advisory or Data Safety Monitoring board for EMD Serono. Dr. Williams has received personal compensation in the range of $10,000-$49,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Genzyme. Dr. Williams has received personal compensation in the range of $5,000-$9,999 for serving on a Scientific Advisory or Data Safety Monitoring board for TG Therapeutics. Dr. Williams has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Alexion. Dr. Williams has received personal compensation in the range of $5,000-$9,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Bristol Myers Squibb. Dr. Williams has received personal compensation in the range of $5,000-$9,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Janssen. Dr. Williams has received personal compensation in the range of $10,000-$49,999 for serving on a Speakers Bureau for Biogen Idec. Dr. Williams has received personal compensation in the range of $10,000-$49,999 for serving on a Speakers Bureau for EMD Serono. Dr. Williams has received personal compensation in the range of $5,000-$9,999 for serving on a Speakers Bureau for Genentech. Dr. Williams has received publishing royalties from a publication relating to health care. Dr. Williams has received publishing royalties from a publication relating to health care. Dr. Williams has a non-compensated relationship as a National Board Member with National MS Society that is relevant to AAN interests or activities.
Vanessa Zimmerman, RN (University of Pennsylvania) Ms. Zimmerman has nothing to disclose.
Leah Zuroff, MD (Hospital of the University of Pennsylvania) Dr. Zuroff has received personal compensation in the range of $500-$4,999 for serving as a Speaker with EMD Serono.
Maria K. Houtchens, MD Dr. Houtchens has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Biogen. Dr. Houtchens has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Roche . Dr. Houtchens has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Novartis. Dr. Houtchens has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Serono. Dr. Houtchens has received personal compensation in the range of $5,000-$9,999 for serving as an Expert Witness for Cravath. Dr. Houtchens has received personal compensation in the range of $5,000-$9,999 for serving as an Expert Witness for Beasley . Dr. Houtchens has received personal compensation in the range of $5,000-$9,999 for serving as an Expert Witness for Biogen. The institution of Dr. Houtchens has received research support from Genzyme. The institution of Dr. Houtchens has received research support from Biogen. The institution of Dr. Houtchens has received research support from Genentech.
Riley Bove, MD, FAAN (University of California, San Francisco) Dr. Bove has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Horizon. Dr. Bove has received personal compensation in the range of $5,000-$9,999 for serving on a Scientific Advisory or Data Safety Monitoring board for EMD Serono. Dr. Bove has received personal compensation in the range of $10,000-$49,999 for serving on a Scientific Advisory or Data Safety Monitoring board for TG Therapeutics. Dr. Bove has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Jansen. The institution of Dr. Bove has received research support from Biogen. The institution of Dr. Bove has received research support from Roche Genentech. The institution of Dr. Bove has received research support from Novartis. The institution of Dr. Bove has received research support from Eli Lilly.