Clinical, Sociodemographic and Neighborhood Characteristics and Adverse Pregnancy Outcomes

Introduction: Adverse pregnancy outcomes (APOs) are risk enhancing factors for future cardiovascular (CV) disease. Our study aims to understand the clinical, sociodemographic and neighborhood factors of patients who suffered APOs in our health system. Methods: We performed a retrospective analysis of 66,136 single-gestation pregnancies from 7 hospitals in the Northwell Health System between March 2018 and June 2020. Pregnancies with known APO status were included in final analysis (n=64,804). Data extracted from EHR included demographics, parity, insurance, hospital of delivery, medical history, and APO outcomes: pre-term birth (PTB), stillbirth (SB), small for gestational age (SGA) and low birth weight (LBW). Median neighborhood household income, percent unemployed, and household size (extracted from census data based on zip code) were used to represent the mean demographics of those living within certain geographic regions. Results: In our study population, the average ±SD age was 31.4 ±5.4 years; 46.9% were white, 12.4% were black, 12.4% were Asian and 52.3% were overweight or obese. The composite incidence of SB, SGA and LBW was 13.8% while incidence of PTB was 7.2%. Being single or having public health insurance had an increased odds of overall APOs, OR 1.4 (95%CI 1.3-1.4) and OR 1.3 (95%CI 1.2-1.3), respectively. Median neighborhood household income was significantly associated with odds of APOs, with lower income categories having increased odds of APOs and odds of PTB compared to higher income categories. Those with a hypertensive disorder (HTN) (during or pre-pregnancy) had increased odds of having an APO compared to those without, OR 2.2 (95%CI 2.1-2.4). Those with HTN, glucose intolerance or obesity (pre-pregnancy BMI ≥ 40) during or pre-pregnancy had increased odds of a PTB compared to those without any of these conditions, OR 3.6 (95%CI 3.4 - 3.9), OR 1.7(95%CI 1.6-1.9) and OR 1.9 (95%CI 1.7-2.2), respectively. Conclusions: CV risk factors, sociodemographic and neighborhood characteristics are likely associated with APOs. These potential relationships may provide useful information for CV prevention in pregnancy. Future research is needed to further elucidate these associations.