Perinatal outcomes amongst Black women living in areas of high social needs

Because black women have higher health disparity and adverse pregnancy outcomes with unclear etiology, we hypothesized that black women living in a geographic area with greater social needs would have worse outcomes compared to those living outside this area. This was a retrospective cohort study of Black women delivering infants at a large inner-city safety net county hospital. Perinatal outcomes of women living within a target region of ten zip codes, identified during a recent CHNA, were compared to those of women living outside the target region. Analyses included student’s t-test, chi square, and logistic and binomial regression, with p< 0.05 significant. Between January 2011 through December 2020, 9,579 non-Hispanic Black women delivered at our hospital. Of these, 2,741 (28.6%) resided in the CHNA target region. The women in the target region were younger (25.7±5.9 vs 28.4±6.2 yrs, p< .001) and had a higher BMI (33.9±8.3 vs 33.0±7.4 kg/m2, p < .001). Women in the target region attended their first prenatal visit at an earlier gestational age (14.3(10.0,22.0) vs 15.6(10.4,24.1) wks, p< .001), and 96% participated in prenatal care prior to delivery in both groups. Women in the target region were less likely to have diabetes but more likely to have either chronic or gestational hypertension (Table 1). The rate of stillbirth, preterm birth, and other complications of prematurity were higher in the target region (Table 2). When outcomes were adjusted for maternal age these differences remained significant. A composite including stillbirth, neonatal death, 5 minute Apgar < 4, pH < 7.0, and grade 3 or 4 intraventricular hemorrhage occurred in 80 (3%) pregnancies in the target region compared to 158 (2%) from other regions, with an adjusted RR of 1.39 (1.05, 1.84). Black women living in areas with high social needs have significantly higher rates of stillbirth, prematurity, and its attendant sequelae compared to those living outside the target region. Evaluation of social determinants of health will likely provide insight into the origin of these differences.View Large Image Figure ViewerDownload Hi-res image Download (PPT)