(693) Social Vulnerability Index (SVI) and Comorbidity Burden among Pregnant Patients with Pregestational Diabetes

Objective: To assess the relationship between social vulnerability index (SVI) and maternal comorbidities and evaluate whether these factors influence adverse maternal or fetal/neonatal outcomes in patients with pregestational diabetes.

Study Design: A multicenter retrospective cohort study of all pregnant patients with pregestational diabetes delivered in a large health system between 2019-2021. ICD-10 codes were used to identify cases. Patient addresses were used to identify census tracts and linked to SVI scores. SVI is a tool released by the Centers for Disease Control and Prevention (CDC) that uses U.S. Census data. If a patient had multiple deliveries, only the first was included. First, we assessed the relationship between SVI and number of pre-existing comorbidities while adjusting for baseline demographic factors. Next, we evaluated the association between composite maternal adverse outcome and SVI, adjusting for number of comorbidities, race-ethnicity, language and insurance type. Finally, the same assessment was made for composite adverse fetal/neonatal outcome. Multivariable logistic regression was performed.

Results: 988 patients with pregestational diabetes were identified and 791 were included for analysis (Table 1). Each 0.1 increase in SVI was associated with 2.1% more comorbidities. Maternal comorbidities were associated with adverse maternal outcomes (OR 1.38, 95% CI: 1.21-1.57) and fetal/neonatal adverse events (OR 1.26, 95% CI: 1.10-1.44). Fetal/neonatal adverse events were more frequent in non-Hispanic Blacks, less frequent in non-English speakers, and less frequent in those with private insurance (Table 2).

Conclusion:

In our cohort of patients with pregestational diabetes, social vulnerability was associated with higher maternal comorbidity. In a multivariable model controlling for SVI, the number of comorbidities was the only factor associated with adverse maternal outcomes. Adverse fetal/neonatal outcome was associated with multiple factors, including maternal comorbidities, race, language, and insurance type.