(1113) Neighborhood crime and adverse obstetrical outcomes in people enrolled in a perinatal collaborative care program

Friday, February 10, 2023

3:30 PM – 5:00 PM

Objective: Exposure to neighborhood crime has been associated with adverse obstetrical outcomes including hypertensive disorders of pregnancy (HDP), yet the mechanism by which this occurs is not yet understood. Psychological stress is one such factor that may mediate this relationship. Our objective was to evaluate the association between neighborhood crime and obstetrical outcomes in patients enrolled in a perinatal collaborative care program with a focus on providing mental health support.

Study Design: This retrospective cohort study evaluated pregnant and postpartum people enrolled in a perinatal collaborative care program at a single institution in Chicago from January 2017 to April 2021. Individual addresses were geocoded and linked to neighborhood crime data from the year prior to delivery. People without an address that could be linked to Chicago City crime data, and those with a previable delivery, stillbirth, or a genetically abnormal or anomalous pregnancy were excluded. The primary exposure was neighborhood total crime rate expressed as tertiles of low, medium, and high crime. The lowest two crime tertiles were compared to the highest crime tertile. The primary outcome was hypertensive disorders of pregnancy (HDP). Secondary outcomes included severe HDP, gestational diabetes, preterm birth (PTB), and spontaneous PTB. Bivariable and multivariable analyses were conducted.

Results:

Characteristics of the 1,095 people who met inclusion criteria are shown in Table 1. HDP and severe HDP were significantly higher in the highest crime tertile and this association persisted after controlling for potential confounders (Table 2). Gestational diabetes, PTB, and spontaneous PTB were not significantly different between the low/medium crime tertile and the high crime tertile on adjusted analyses (Table 2).

Conclusion:

Despite enrollment in a perinatal collaborative care program for mental health support, higher neighborhood crime was significantly associated with HDP and severe HDP. Exposure to neighborhood crime may be an important social determinant of obstetric health.

Primary & Presenting Author(s)

Nigel Madden, MD (she/her/hers)
McGaw Medical Center of Northwestern University
Chicago, Illinois, United States

Coauthor(s)

Alexa A. Freedman, PhD (she/her/hers)
NorthShore University HealthSystem
Evanston, Illinois, United States
Allie Sakowicz, MS
Medical Student
Wake Forest School of Medicine
Winston-Salem, North Carolina, United States
GM
Greg E. Miller, MPH, PhD
Northwestern University
Evanston, Illinois, United States
KK
Kiarri N. Kershaw, MPH, PhD
Associate Professor
Northwestern University
Chicago, Illinois, United States
Emily S. Miller, MD, MPH (she/her/hers)
Director, Division of Maternal-Fetal Medicine
Alpert Medical School of Brown University and Women & Infants Hospital of Rhode Island
Providence, Rhode Island, United States