A wide range of interconnected social characteristics may work together to promote adverse pregnancy outcomes (APOs), potentially explaining some of the inequities observed today, according to a study recently published in Pregnancy.
The study focused on social determinants of health, which are environmental and non-medical factors that influence overall health and well-being. Many specific social determinants such as access to care and socioeconomic status have already been linked with APOs. This study employed a network analysis to better understand how these traits interact with one another.
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For individuals with diseases such as fetal and neonatal alloimmune thrombocytopenia (FNAIT), who are at an increased risk of adverse outcomes, understanding these interrelationships is important for combining structural change with medical prevention.
The study included 5708 participants. Of these, 22.7% experienced an APO, such as hypertensive disorders of pregnancy, gestational diabetes, preterm birth, small size for gestational age or stillbirth.
Overall, individuals experiencing an APO were more likely to have a higher body mass index (BMI), be unemployed, be unmarried and identify as non-Hispanic Black. They also had higher rates of perceived depression, stress and anxiety and were more likely to smoke before pregnancy.
“The network had a hierarchical organization, with race and structural conditions positioned upstream, psychosocial factors in an intermediate tier, and metabolic conditions most proximal to the outcome,” the researchers wrote.
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In the final network, increased BMI and pregestational diabetes mellitus were the only variables directly associated with APOs. Pregestational diabetes mellitus was associated with 3.55 times the odds of an APO, and higher BMI was linked with 1.36 times the odds of an APO.
Non-Hispanic Black race was further upstream of all other variables and was not directly related with APOs. However, race was associated with several characteristics such as unemployment, lack of social and emotional support, use of public insurance and elevated BMI. All of these factors acted as mediators that tied race to pregnancy outcomes.
These findings support the use of multilevel, network-based analyses to inform interventions that address social, structural and clinical risk factors, the authors concluded.
