(1190) Association between social vulnerability and maternal and neonatal outcomes in patients with gestational diabetes

Friday, February 10, 2023

3:30 PM – 5:00 PM

Objective: Social circumstances and environmental exposures are important contributors to healthcare access. We sought to determine the impact of neighborhood-level factors on maternal and neonatal outcomes in pregnancies affected by gestational diabetes (GDM).

Study Design: This was a retrospective cohort study of pregnancies complicated by GDM between 2011 and 2019 in a single academic center. Social determinants of health were approximated using the social vulnerability index (SVI) created by the Center for Disease Control and Prevention. Traditionally used for disaster relief, SVI encompasses US census data based on 15 categories (poverty level, employment, income, family composition, transportation, etc) to calculate a composite metric that represents the resilience of communities to external stressors. A SVI score closer to 1.0 indicates greater social vulnerability. The SVI was analyzed into three groups: low (SVI ≤ 0.3), medium (SVI 0.3-0.7) and high (SVI > 0.7). Frequencies of composite maternal and composite neonatal outcomes were compared among the three groups using univariate and multivariate models.

Results: A total of 893 patients were included in the analysis, with 353 (39.5%) included in the low SVI group, 261 (29.2%) in the medium, and 279 (31.3%) in the high SVI group. Patients in the high SVI group were more likely to be young (p < 0.001), black (p < 0.001), nulliparous (p=0.002), single (p < 0.001), and publicly insured (p < 0.001). Frequencies of chronic hypertension and mood disorders were similar across the groups. The rate of maternal composite outcome did not differ between the three groups while neonatal composite outcome was highest in the high SVI group (54.1% in the high SVI group, 42.5% in the medium SVI group, and 38.8% in the low SVI group, p < 0.001). After adjusting for confounding factors, high SVI remained significantly associated with higher odds of composite neonatal outcome (aOR 1.57, 95% Cl 1.05-2.34).

Conclusion: Among patients with GDM, high SVI was associated with adverse neonatal outcomes and may present a method of targeted screening to direct healthcare efforts.

Primary & Presenting Author(s)

Yiwen Cui, MD
Medical College of Wisconsin
Milwaukee, Wisconsin, United States

Coauthor(s)

AP
Amy Y. Pan, PhD
Medical College of Wisconsin
Milwaukee, Wisconsin, United States
Rachel Harrison, MD
Advocate Christ Hospital
Oak Lawn, Illinois, United States
MC
Meredith Cruz, MBA, MD, MPH
Medical College of Wisconsin
Milwaukee, Wisconsin, United States
SO
Stephanie Olivier-Van Stichelen, PhD
Department of Biochemistry, Medical College of Wisconsin
Milwaukee, Wisconsin, United States
Anna Palatnik, MD
Medical College of Wisconsin
Milwaukee, Wisconsin, United States