(785) Prenatal care disparity and pregnancy outcome among incarcerated pregnant individuals in the United States

PubMed/MedLine, Embase, ClinicalTrials.gov and Web of Science were searched from inception up to March 30^th, 2022. Of the 1,760 articles screened, 9 studies were included in the final review. Studies were included if they reported the risk of inadequate prenatal care as well as pregnancy outcomes among incarcerated pregnant individuals in the United States jails or prisons. Adequacy of prenatal care was quantified by Kessner index using recommended number of prenatal visits by American College of Obstetricians and Gynecologists (Figure 1).

Results:

The random-effects model was used to pool the mean differences or odds ratios (OR) and the corresponding 95% confidence intervals (CIs) using RevMan software. A total of 11,534 pregnant individuals, of whom 2,544 were incarcerated while pregnant, and 8,990 who were matched non-incarcerated pregnant individuals serving as control group, were utilized. Compared to non-incarcerated pregnancies, incarcerated pregnant individuals were at higher risk of inadequate prenatal care (OR 2.99 (95% CI: 1.60, 5.61), P < 0.001) and were more likely to have newborns with low birthweight (OR 1.66 (95% CI: 1.19, 2.32), P=0.003). There was no significant difference between incarcerated and matched control pregnancies in the rates of preterm birth and stillbirth (Figure 2).

Conclusion: Incarceration was found to increase the risk of inadequate prenatal care for pregnant individuals. Considering the limited number of current studies, further research is indicated to both assess whether the risk of inadequate prenatal care has negative impact on prenatal outcomes for this population and to determine the steps that can be taken to enhance prenatal care for all pregnant individuals incarcerated in the United States prisons.