Objectives: To describe utilization of specialised prenatal care by high-risk survivors and evaluate echocardiogram use in echocardiogram-need survivors, as per survivorship guideline recommendations. Methods: Retrospective population-based matched survivor:control study utilizing Ontario health administrative data. Survivors were classified as high-risk/low-risk for obstetrical outcomes, and as echocardiogram-need (yes/no) for echocardiogram outcomes. Associations were tested using logistic regression. Results: 11% (n=363) of 3,204 pregnant survivors were classified as high-risk. Over 90% received specialized prenatal care. Living in a rural area was associated with lower use. (AOR 0.51; 95% CI 0.44-0.59). Since 2003, 32% (560/1,737) of survivors had an echocardiogram-need. Only 14% (77/560) had ≥1 echocardiogram, this was not associated with rurality nor neighbourhood income quintile. Conclusions: Although the majority of high-risk survivors receive specialized prenatal care, geographic inequality in care persists. Despite survivorship guidelines, >85% of echocardiogram-need pregnant survivors do not have an echocardiogram performed; future work should address this gap in care.

Objectives: To describe utilization of specialised prenatal care by high-risk survivors and evaluate echocardiogram use in echocardiogram-need survivors, as per survivorship guideline recommendations. Methods: Retrospective population-based matched survivor:control study utilizing Ontario health administrative data. Survivors were classified as high-risk/low-risk for obstetrical outcomes, and as echocardiogram-need (yes/no) for echocardiogram outcomes. Associations were tested using logistic regression. Results: 11% (n=363) of 3,204 pregnant survivors were classified as high-risk. Over 90% received specialized prenatal care. Living in a rural area was associated with lower use. (AOR 0.51; 95% CI 0.44-0.59). Since 2003, 32% (560/1,737) of survivors had an echocardiogram-need. Only 14% (77/560) had ≥1 echocardiogram, this was not associated with rurality nor neighbourhood income quintile. Conclusions: Although the majority of high-risk survivors receive specialized prenatal care, geographic inequality in care persists. Despite survivorship guidelines, >85% of echocardiogram-need pregnant survivors do not have an echocardiogram performed; future work should address this gap in care.