(1025) Obstetric and neonatal outcomes associated with elevated environmental justice indices

A retrospective cohort of all pregnancies delivered at >23 weeks of gestational age at seven hospitals within a large academic health system in New York from 2019-2021. For patients with more than one pregnancy during the study period, only the first was included for analysis. Patient home address data was used to identify census tracts and linked to EJI scores released by the U.S. Environmental Protection Agency (EPA). Patients with missing EJI or body mass index (BMI) data were excluded. The included patients were divided into two groups: high cumulative EJI (HcEJI), defined as more than 6 (of the 12) EJI indices exceeding the 75th percentile, and low cumulative EJI (LcEJI), defined as 6 or less. Demographic information, clinical characteristics, and pregnancy outcomes were obtained from the electronic medical record system. Maternal and neonatal outcomes were compared between the two groups.

Results: A total of 59,233 patients were included: 31% HcEJI and 69% LcEJI. Baseline clinical and demographic information are shown in Table 1. Patients with a HcEJI were more likely to be Hispanic, have a higher pre-pregnancy BMI, or have a diagnosis of diabetes or asthma (Table 1). Compared to patients with LcEJI, those with HcEJI were more likely to be diagnosed with preeclampsia with severe features (7.1% vs. 4.8%, P< 0.001; Table 2). Neonates born to mothers with HcEJI were more likely to be born preterm, have lower birthweights, more Neonatal Intensive Care Unit (NICU) admissions, and lower 5-minute APGAR scores.

Conclusion: Increased environmental exposure burden, as indicated by hcEJI, is associated with adverse maternal and neonatal outcomes. Further research is necessary to better understand how these environmental factors affect pregnancy.