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11. Social vulnerability and prenatal diagnosis.

Author

Kouba, Insaf, Del Pozzo, Jaclyn, Alvarez, Alejandro, Keller, Nathan A., Palmer, Alexis, Bracero, Luis A., and Blitz, Matthew J.

Subjects
SOCIAL determinants of health, CHORIONIC villus sampling, LOGISTIC regression analysis, PRENATAL diagnosis, RETROSPECTIVE studies, GENETIC counseling, FETAL ultrasonic imaging, ODDS ratio, MEDICAL records, ACQUISITION of data, FETAL abnormalities, CONFIDENCE intervals, NEIGHBORHOOD characteristics, PSYCHOLOGICAL vulnerability, AMNIOCENTESIS
Abstract

There are limited data on how neighborhood-level risk factors affect the likelihood of having prenatal diagnosis. Neighborhood social vulnerability can be quantified and ranked using the social vulnerability index (SVI), a tool that measures the cumulative effect of external stressors in the local environment that may affect health outcomes. The objective of the study was to determine the relationship between SVI and prenatal diagnosis among pregnant patients who received genetic counseling. Retrospective cohort study of all pregnant patients who had genetic counseling at two hospitals in New York between January 2019 and December 2022. For each patient, the address of residence was linked to an SVI score (primary exposure) based on census tract. SVI scores were subdivided into fifths and analyzed categorically. The primary outcome was prenatal diagnosis (yes/no). Multivariable logistic regression was performed. A total of 5,935 patients were included for analysis and 231 (3.9 %) had prenatal diagnosis. On regression analysis, no association between SVI and prenatal diagnosis was observed. Patients who had a diagnostic procedure were more likely to be English speaking (aOR 1.80; 95 % CI 1.13–2.87), carriers of a genetic disorder (aOR 1.94; 95 % CI 1.32–2.86), had increased NT (aOR 6.89; 95 % CI 3.65–13.00), abnormal NIPS (aOR 9.58; 95 % CI 5.81–15.80), or had fetal structural anomalies (aOR 10.60; 95 % CI 6.62–16.96). No differences were seen based on race and ethnicity group, insurance type, or marital status. SVI score does not affect rate of prenatal diagnosis. Findings may differ in other geographic regions and populations. [ABSTRACT FROM AUTHOR]

Published
2024
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32. Clinical, Sociodemographic, and Neighborhood Characteristics Associated with Adverse Pregnancy Outcomes.

Author

Thermidor, Sadiya, Gaballa, Dianna, Hentz, Roland, Fishbein, Joanna, Vaidean, Georgeta, Weinberg, Catherine, Pachtman, Sarah, Blitz, Matthew J., Grayver, Evelina, and Gianos, Eugenia

Subjects
RISK assessment, CROSS-sectional method, SMALL for gestational age, RESEARCH funding, DATA analysis, PREMATURE infants, RESIDENTIAL patterns, SOCIOECONOMIC factors, LOGISTIC regression analysis, PREGNANCY outcomes, PERINATAL death, DESCRIPTIVE statistics, LOW birth weight, ODDS ratio, RACE, ELECTRONIC health records, STATISTICS, SOCIODEMOGRAPHIC factors, DATA analysis software, CONFIDENCE intervals
Abstract

Background: Cardiovascular risk is increased by a history of adverse pregnancy outcomes (APOs). Efforts to understand and prevent these adverse outcomes may improve both fetal and birthing persons' outcomes in the peripartum period, and over the patient's lifetime. This study aims to assess the association of clinical, sociodemographic, and economic neighbor-hood factors with preterm birth (PTB) and APOs (the composite of stillbirth, small for gestation age, and low birthweight). Materials and Methods: This is a cross-sectional study using the electronic medical records of deliveries from seven Northwell Health hospitals between January 1, 2018 and July 31, 2020. There were 62,787 deliveries reviewed in this study. Deliveries that were not the first for the patient during the study period and multiple gestational pregnancies were excluded. Patients with incomplete data on outcome were also excluded. Main outcomes were PTB and composite APOs. Measures included history of PTB, hypertension, diabetes, body mass index, race/ethnicity, age, preferred language, marital status, parity, health insurance, and median income, percent unemployment, and mean household size by zip code. Results: Of the 62,787 deliveries, 43.3% were from white, Non-Hispanic, and Non-Latino patients. There were 4,552 (7.2%) PTBs and 8,634 (13.8%) APOs. Patients enrolled in public insurance had higher odds of PTB (odds ratio [OR] 1.15, 95% CI 1.06–1.24) and APOs (OR 1.19, 95% CI 1.12–1.25). There was a statistically significant association of both PTB (p = 0.037) and APOs (p = 0.005) when comparing patients that live in a zip code with a median income over 100k to those with an income <100k. In addition, living in a zip code within the second quintile of unemployment was associated with lower odds of APOs (OR 0.92, 95% CI 0.84–0.99). Conclusions: Numerous sociodemographic and clinical factors are associated with both PTB and APOs. Tailored programs addressing these disparities may improve outcomes in pregnant persons. [ABSTRACT FROM AUTHOR]

Published
2024
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34. Association of Maternal Comorbidity Burden With Cesarean Birth Rate Among Nulliparous, Term, Singleton, Vertex Pregnancies

Author

Wetcher, Cara S., primary, Kirshenbaum, Rachel L., additional, Alvarez, Alejandro, additional, Gerber, Rachel P., additional, Pachtman Shetty, Sarah L., additional, De Four Jones, Monique, additional, Suarez, Fernando, additional, Combs, Adriann, additional, Nimaroff, Michael, additional, Lewis, Dawnette, additional, and Blitz, Matthew J., additional

Published
2023
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