48 - Neighborhood socioeconomic disadvantage and abnormal fetal growth

Friday, February 10, 2023

3:00 PM – 3:15 PM

Location: Room 3009, Moscone West, Level 3

Objective: To examine whether neighborhood socioeconomic disadvantage is associated with an increased risk of abnormal fetal growth.

Study Design: A secondary analysis from the prospective cohort Nulliparous Pregnancy Outcomes Study: Monitoring Mothers-To-Be. Participant addresses were geocoded at the census tract and linked to the 2015 Area Deprivation Index (ADI). The ADI incorporates the domains of income, education, employment, and housing quality into a composite national ranking of neighborhood socioeconomic disadvantage, and was analyzed in quartiles from the lowest (quartile 1 [Q1], least disadvantaged, reference) to the highest (Q4, most disadvantaged). Outcomes were large-for-gestational age (LGA, birthweight >90^th percentile) and small-for-gestational age (SGA, birthweight < 10^th percentile) in comparison with appropriate-for-gestational age (AGA, birthweight 10^th-90^th percentile), per 2017 U.S. natality reference data, standardized for fetal sex. Multinomial logistic regression models adjusted for age, insurance, and self-reported race and ethnicity as a social determinant of health, but not hypertension, diabetes in pregnancy, and BMI, which were considered to be on the causal pathway between the exposure and outcome and were adjusted for in sensitivity analyses.

Results: Of 8,983 assessed pregnant individuals, 12.7% (n=1,143) were SGA, 8.2% (n=738) were LGA, and 79.1% (n=7,102) were AGA. The frequency of SGA generally increased with quartile of neighborhood deprivation (p < 0.001), as did the frequency of LGA (p < 0.01) (Figure). Compared with those living in Q1, individuals living in Q4 were more likely to have a SGA infant (aOR: 1.24; 95% CI: 1.02-1.51); and individuals living in each of Q2-4 were more likely to have a LGA infant (aOR: Q2: 1.43; 95% CI: 1.14-1.78; Q3: 1.50; 95% CI: 1.20-1.88; and Q4: 1.43; 95% CI: 1.11-1.84). These results held for SGA, but were attenuated for LGA in sensitivity analyses (Table).

Conclusion:

Nulliparous pregnant individuals living in U.S. neighborhoods with higher area deprivation were more likely to have abnormal fetal growth at the extremes (i.e., SGA and LGA).

Primary & Presenting Author(s)

Kartik Kailas Venkatesh, MD, PhD (he/him/his)

Assistant Professor
The Ohio State University
Columbus, Ohio, United States

Slides

Coauthor(s)

Lynn M. Yee, MD,MPH (she/her/hers)

Associate Professor
Northwestern University Feinberg School of Medicine
Chicago, Illinois, United States
Jasmine D. Johnson, MD (she/her/hers)

Assistant Professor of Clinical Obstetrics & Gynecology
Indiana University School of Medicine
Carmel, Indiana, United States
RM

Rebecca B. McNeil, PhD

RTI International
Research Triangle, North Carolina, United States
Judith H. Chung, MD, PhD

Professor of Clinical Obstetrics and Gynecology
UC Irvine Health
Orange, California, United States
Brian M. Mercer, MD

Department Chair of Obstetrics & Gynecology
Case Western Reserve University and The MetroHealth System
Cleveland, Ohio, United States
Hyagriv Simhan, MD

Professor
University of Pittsburgh
Pittsburgh, Pennsylvania, United States
Uma M. Reddy, MD,MPH

Professor and Vice Chair of Research, Department of Obstetrics and Gynecology
Columbia University
New York, New York, United States
RS

Robert M. Silver, MD

University of Utah Health
Salt Lake City, Utah, United States
Samuel Parry, MD

Perelman School of Medicine, University of Pennsylvania
Philadelphia, Pennsylvania, United States
Ronald J. Wapner, MD

Professor of OBGYN; Vice Chair of Research; Director of Reproductive Genetics
Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, Columbia University Irving Medical Center
New York, NY, United States
George R. Saade, MD

Professor & Chief of Obstetrics & Maternal-Fetal Medicine
University of Texas Medical Branch
Galveston, Texas, United States
Courtney Denning-Johnson Lynch, MPH, PhD

Associate Professor, Obstetrics & Gynecology and Epidemiology
The Ohio State University
Columbus, Ohio, United States
William A. Grobman, MD, MBA

Vice Chair, Clinical Operations, Maternal Fetal Medicine
The Ohio State University
Columbus, Ohio, United States