P1.177: The Changing Landscape of Planned Out-of-Hospital Births

Background: Planned out-of-hospital (OOH) births are increasing within the United States, with the COVID-19 pandemic potentiating an already upward trend. American College of Obstetricians and Gynecologists recommends strict selection criteria for OOH births: absence of preexisting maternal disease, cephalic presentation, and term singleton gestation. Infants born to low-risk women choosing OOH births more frequently experience adverse neonatal events .To date, no study has examined changes in the maternal risk profile and neonatal outcomes for planned OOH births since declaration of the pandemic. We hypothesized maternal risk factors and rates of adverse neonatal outcomes for planned OOH births have increased since declaration of the COVID-19 pandemic. Study objectives are to describe the sociodemographic profiles and maternal risk factors among those with planned OOH births pre/post the COVID-19 pandemic and compare neonatal outcomes pre/post the COVID-19 pandemic.

Methods: This retrospective cohort study includes pregnant individuals and their neonates with planned OOH births in Cincinnati and surrounding areas between January 1, 2018 - February 29, 2020 (pre-pandemic), and April 1, 2020 - December 31, 2023 (post-pandemic). We extracted variables of interest from Ohio Department of Health birth certificate and vital statistics files. Maternal characteristics and potential risk factors for adverse neonatal outcomes are reported using descriptive statistics. Comparisons between groups are evaluated using Wilcoxon rank sum test for continuous variables and Chi-square or Fisher’s exact test for categorical variables

Results: We identified 1601 planned OOH births; 1234 occurred during the post-pandemic era. The incidence of planned OOH births doubled from 1.5% pre-pandemic to 3.0% post-pandemic. As described in Table 1, women with post-pandemic OOH births had statistically significant (p < 0.05) increases in Black or Asian race, Hispanic ethnicity, obese/overweight, and completion of a high school, collegiate, or graduate degree. Statistically significant decreases were noted in mean age, white race, number of prenatal visits, and underweight persons. Neonatal characteristics, rates of adverse events, and completion of routine screenings were largely unchanged between cohorts (Table 2). Ocular prophylaxis agent and use differed between groups; more families opted against prophylaxis in the post-pandemic group. Analysis is ongoing to compare neonatal outcomes of OOH births to a matched in-hospital birth group

Conclusion: Planned OOH births doubled post COVID-19 pandemic, reaching 3.0% of births in our study region by 2023. Sociodemographic profiles and maternal risk factors varied between study groups; notably, younger and more educated mothers are choosing OOH births. While maternal characteristics, such as BMI category, in the post-pandemic cohort may confer increased neonatal risk, it is reassuring that despite the significant increase in OOH births, neonatal characteristics and outcomes have remained similar with low absolute rates of adverse events. Analysis is ongoing to assess the impact of an evolving risk profile on neonatal outcomes compared to planned in-hospital births.