916: The association of race/ethnicity and neighborhood poverty with gestational weight gain

Abstract

To examine the association of race/ethnicity and neighborhood poverty with gestational weight gain (GWG). This is a retrospective cohort study of women who delivered singletons between 2009-2013 at a large academic institution. The hospital’s electronic databases were queried for demographic information, pre-pregnancy weight, delivery weight and height. Women’s addresses were extracted and geocoded based on their census-tract location. The measure of neighborhood-level poverty, based on census tract, was obtained from American Community Survey data and converted to standard deviations from the mean. Patients with incomplete weight or address data were excluded from analysis. Expected gestational weight gain (GWG) was calculated based on Institute of Medicine (IOM) recommended weight gain during the first trimester and rate of weight gain during the second and third trimester. A ratio of observed GWG/expected GWG was used to categorize total GWG using IOM recommended GWG based on pre-pregnancy body mass index (BMI). Multivariable analysis was conducted using multinomial logistic regression that accounted for clustering by census tract. A total of 29,380 women were eligible for analysis. Women were classified by pre-pregnancy BMI as underweight (3.3%), normal weight (58.6%), overweight (22.5%) and obese (15.1%). GWG was classified as weight loss (0.3%), inadequate (15.4%), adequate (42.5%), and excessive (41.8%). Compared to women with adequate GWG, women experiencing gestational weight loss were significantly more likely to live in a neighborhood with higher poverty (RRR 1.21, CI 1.03-1.43) and to be of Black (RR 8.82, CI 4.36-17.85) or Hispanic (RR 3.23, CI 1.54-6.78) race/ethnicity. While women with inadequate and excessive GWG also were significantly more likely to be of minority race, high neighborhood poverty was not an additional factor associated with adverse GWG. Gestational weight loss is significantly associated not only with race and ethnicity but with higher neighborhood poverty as well. As multiple adverse pregnancy outcomes are associated with gestational weight loss, our findings underscore that neighborhood poverty is one social determinant of health that may be targeted in an effort to improve pregnancy outcomes and lessen obstetric racial disparities.