520 Residence in an area with high social vulnerability is associated with placentally-mediated pregnancy outcomes

Abstract

We sought to determine if women living in census tracts with high social vulnerabilities have increased odds of placentally-mediated adverse pregnancy outcomes [preeclampsia and small for gestational age (SGA) <10% and <3%]. Retrospective cohort study of women carrying non-anomalous singleton or twin gestations from a large university-based healthcare system, 2014-2020. Women at high risk for spontaneous ± medically indicated PTB were included in a 1:2 ratio with randomly selected low-risk controls. Each woman’s home address was geocoded and assigned to a census tract, and then linked at the census tract level to the CDC’s Social Vulnerability Index (SVI). The SVI integrates 15 census variables to produce composite scores across 4 major domains (D1=socioeconomic, D2=household composition and disability, D3=minority status and language, and D4=housing type and transportation) in addition to an overall composite SVI score. Higher scores indicate greater social vulnerability. The primary outcomes were preeclampsia and SGA<10% and <3% at birth (by gestational age and fetal sex). Data were analyzed using chi2, t-test, and logistic regression. 50,998 women met inclusion criteria; 3,516 (6.9%) developed preeclampsia, 4,650 (9.1%) delivered SGA<10% and 829 (1.6%) SGA<3% neonates. Population characteristics are shown in Table 1. Preeclampsia was not associated with SVI, but women delivering neonates SGA<10% and <3% were more likely to live in areas with higher social vulnerability in D3 and D4, Table 1. In regression models, the aOR of preeclampsia decreased with increasing overall SVI and social vulnerability in D1 and D2, whereas the aOR of SGA<10% and <3% increased with increasing social vulnerability in D3 and D4. Increasing social vulnerabilities at the census tract level of a woman's residence in pregnancy are associated with a lower odds of preeclampsia, but higher odds of SGA <10% and <3%, albeit in different domains. Further elucidation of specific neighborhood-level factors influencing pregnancy outcomes may lead to novel strategies to reduce morbidities.View Large Image Figure ViewerDownload Hi-res image Download (PPT)