800: Area deprivation index and adverse obstetric outcomes

Abstract

Preterm birth and low birth weight continue to be vexing obstetric and pediatric problems, complicating many pregnancies, with few effective interventions, and troubling racial disparities. Our objective was to examine the associations between area deprivation index (ADI), race, and adverse obstetric outcomes to target populations at highest risk. This is a prospective cohort study enrolling pregnant women early in pregnancy and following them longitudinally at a tertiary care center in Missouri. ADI was calculated using the “Neighborhood Atlas” (University of Wisconsin), which uses census data to rank areas based on multiple measures of socioeconomic disadvantage such as income, education, employment, housing quality etc. ADI was calculated using Missouri state data based on the woman’s residential address at enrollment. Preterm birth < 37 weeks and low birth weight (birthweight < 2500 grams) were compared across ADI quartiles from the least (1st quartile) to the most (4th quartile) disadvantaged. The analysis was stratified by race to explore the effect of race on the relationship between deprivation and adverse obstetric outcomes. 848 pregnant women were included. Low birth weight significantly increased as ADI increased, from 7% in areas of lowest deprivation to 20% in areas of highest deprivation (Table). Preterm birth less than 37 weeks and less than 34 weeks increased as deprivation increased with a 2 times higher risk for PTB < 37 and and nearly 3 times the risk for PTB < 34 weeks at the highest quartile of neighborhood deprivation. Notable disparities exist with nonblack women even at the most highly disadvantaged ADI still having a lower risk for LBW (8.3%) than black women at low ADI (17.4%). Increasing ADI is associated with a significant increase in risk for LBW and to a smaller extent risk for preterm birth, with notable racial disparities. Future studies testing actionable screening and prevention interventions targeted specifically for populations living in high neighborhood disadvantage should be performed to minimize risk for LWB and PTB outcomes.View Large Image Figure ViewerDownload Hi-res image Download (PPT)