Am J Perinatol. 2024 Dec 24. doi: 10.1055/a-2507-7371. Online ahead of print.
ABSTRACT
Objective We aimed to determine the relationships between socioeconomic disadvantage, as measured by the Social Deprivation Index (SDI), and prenatal care (PNC) utilization, obstetrical outcomes, and neonatal complications. Study Design All spontaneously-conceived singleton deliveries of nulliparous gravidae with residence zip code available (n= 4,786) were identified in a population-based database. Deliveries were assigned SDI scores based on preconception zip code. SDI scores (1-100) are a composite measure of seven community demographic characteristics of poverty, education, transportation, employment, and household composition. SDI scores were categorized into quartiles and grouped for analysis [Q1 (n=1,342), Q2+3 (n=1,752), and Q4 (n=1,692)] with higher scores indicative of greater disadvantage. Statistical analysis was performed using a generalized linear mixed method. Results Among our cohort, gravidae in the lowest (least-deprived) SDI quartile (Q1) were older, had lower pre-pregnancy body mass indices, and were more likely to receive PNC from a physician specializing in Obstetrics and Gynecology. Gravidae residing in the highest (most-deprived) SDI quartile (Q4) attended fewer prenatal visits [mean (standard deviation) 11.17 (2.9)] than those living in Q1 [12.04 (2.3), p < 0.0001]. Gravidae in Q4 were less likely to receive sufficient PNC compared to those in Q1 (52 vs. 64.2%, p < 0.0001) and were more likely to fail to achieve appropriate gestational weight gain (GWG) (19.6 in Q4 vs. 15.9% in Q1, p < 0.01). No significant differences in composite maternal (CMM) or neonatal morbidity (CNM) were associated with SDI quartile. Conclusions Outer quartile social deprivation was associated with higher proportions of primigravidae not meeting recommendations for GWG and attending fewer prenatal visits, but it did not affect CMM or CNM. Improving care access and providing nutritional support to all gravidae are likely important steps toward health equity.
PMID:39719263 | DOI:10.1055/a-2507-7371
