Abstract 12219: Social Vulnerability and Cardiometabolic Risk Factors in Pregnant Women in the United States

Abstract

Background: In recent years, pregnancy-related mortality rates in the US have increased, with cardiovascular disease accounting for a third of all pregnancy-related mortality. The association between cardiometabolic (CM) health and social determinants of health have not been well understood. Objectives: We sought to investigate the relationship between social vulnerability and prevalence of CM risk factors in pregnant women in the US. Methods: In this cross-sectional analysis, we linked natality files including all pregnancies resulting in live births in the US (aggregated 2016-2020) with county-level social vulnerability index (SVI), a composite metric of social risk factors with four major domains: socioeconomic, household composition/disability, minority status/language, and housing type/transportation. We investigated the association between SVI and its subdomains with county-level prevalence of maternal pre-pregnancy diabetes, pre-pregnancy hypertension, tobacco use, and obesity. Results: A total of 18,953,511 pregnancies were analyzed across 577 counties. All CM risk factors were associated with SVI and/or its 4 subcomponents to varying degrees. Obesity was strongly associated with overall SVI (R=0.52, P<0.001) with an even stronger relationship with socioeconomic vulnerability (R=0.6, P<0.001) and household composition/disability (R=0.66, P<0.001). The rate of pre-pregnancy diabetes was associated with overall SVI (R=0.27, p<0.001), with similar association with socioeconomic vulnerability (R=0.26, P<0.001) and household composition/disability (R=0.28, P<0.001). Chronic hypertension was weakly associated with overall SVI (R=0.15, P<0.001) with similar association with socioeconomic vulnerability (R=0.19, P<0.001) and household composition/disability (R=0.22, P<0.001). Tobacco use was not associated with overall SVI (R=0.034, p=0.41), but was strongly associated with minority status/language (R=-0.71, P<0.001). Conclusion: Social vulnerability and its domains are associated with prevalence of CM risk factors in pregnant women in the US. Further studies are needed to investigate the impact of targeting social determinants of health to improve CM risk and mortality in pregnant women.