936 Sociodemographic factors and maternal and neonatal outcomes in obese women (BMI≥30)

Abstract

Sociodemographic (SD) factors and obesity (BMI>30) are correlated, and both are associated with poor perinatal outcomes including preeclampsia, preterm birth, low birthweight, and perinatal death. Which specific SD factors are associated with poor outcomes in these women is understudied. We evaluated SD factors independently associated with poor maternal and neonatal outcomes in obese women. This was a retrospective cohort study of Medicaid funded women offered enhanced social and nutritional services through the Strong Start Program (1/2013-12/2015). We included women with singletons and BMI≥30 at first prenatal visit. Primary outcomes were composite maternal and neonatal morbidity (Figure). We evaluated 24 maternal and partner sociodemographic and other characteristics for association with maternal and neonatal morbidity (Table). Chi-square, Fisher’s exact, Student’s t-test, and Wilcoxon rank sum tests were used to compare outcomes across exposures. We used multivariable logistic regression models with backward selection to determine most significant SD factors associated with maternal and neonatal morbidity. 411 women were included for analysis: 243 (59%) with maternal morbidity, 195 (47%) with neonatal morbidity. Multiple sociodemographic factors were significantly associated with maternal and neonatal morbidity (see table for bolded exposures), all with p<0.01. After multivariable analyses, high school education, and paternal unemployment as well as multiparity chronic hypertension, and pre-gestational diabetes, were factors most associated with maternal outcomes (Figure). Family financial support and paternal full time employment as well as the medical co-morbidities were associated with neonatal outcomes (Figure). In low-income women with BMI≥30, specific maternal and partner social factors and preexisting medical conditions are independently associated with adverse outcomes. This suggests poor outcomes in these women may arise from a complex interplay of lack of financial/social support and medical comorbidities.View Large Image Figure ViewerDownload Hi-res image Download (PPT)