Living in a Neighborhood With Limited Access to Broadband Internet Is Associated With Adverse Pregnancy Outcomes [ID 2683563

Abstract

INTRODUCTION: The internet is an essential tool for ensuring health care access and delivery. We aimed to estimate the association between living in an area with limited broadband internet access and specific adverse pregnancy outcomes. METHODS: We performed an electronic health record-based retrospective cohort study of pregnant people who delivered at a referral medical center between September 1, 2019, and June 1, 2022. Primary outcomes were preterm birth, low birth weight (less than 2,500 g) and birth weight z-score for gestational age. Neighborhood internet access was defined as the proportion of residents with internet access in the pregnant person’s census tract of residence, based on the 2020 American Community Survey estimate and determined by geocoding. We used multivariable logistic or linear regression analysis to estimate the independent effect of internet access and computed adjusted odds ratios (aOR) or mean differences with 95% CIs for a 5-unit increase in the proportion with internet access for a given census tract. RESULTS: Among 5,190 pregnant people included, 885 (17.1%) had a preterm birth, 728 (14.0%) delivered a low-birth weight neonate, and 515 (9.9%) had a small-for-gestational age neonate. After adjusting for relevant confounders, increasing internet access was associated with reduced odds of preterm birth (aOR 0.97; 95% CI, 0.93–1.00; P=.048), reduced odds of low birth weight (aOR 0.95; 95% CI, 0.91–0.98), and increasing birth weight z-score (Beta 0.02; 95% CI, 0.01–0.03). CONCLUSION: Living in neighborhoods with better broadband internet coverage was associated with reduced odds of preterm birth, decreased odds of delivering a low-birth weight neonate, and increasing birth weight.