Poster Session 1
Category: Health Equity/Community Health
Poster Session 1
Noor K. Al-Shibli, MD (she/her/hers)
MFM Fellow
Emory University School of Medicine
Emory University School of Medicine, Georgia, United States
Elizabeth C. Rhodes, MS, PhD
Rollins School of Public Health, Emory University
Atlanta, Georgia, United States
Erin Ferranti, MPH, PhD (she/her/hers)
Nell Hodgson Woodruff School of Nursing, Dept of Gynecology & Obstetrics, Emory University
Nell Hodgson Woodruff School of Nursing, Dept of Gynecology & Obstetrics, Emory University/ Atlanta, Georgia, United States
Anne L. Dunlop, MD, MPH
Department of Gynecology and Obstetrics, Division of Research, Emory University School of Medicine
Dept of Gynecology & Obstetrics, Division of Research, Emory University School of Medicine/ Atlanta, Georgia, United States
Suchitra Chandrasekaran, MD, MSCE
Associate Professor
Department of Gynecology and Obstetrics, Emory University School of Medicine
Atlanta, Georgia, United States
Food deserts (FD), regions with limited access to nutritious and affordable foods, often reflect broader social and geographic inequities. In non-pregnant populations, FD residence has been linked to poorer mental health outcomes & substance use disorders (SUD). Given that maternal mental health disorders (MMHD) & SUD are leading contributors to maternal mortality in the U.S., we sought to examine associations between living in a FD & the risk of MMHD & SUD.
Utilizing our institutional obstetric database, we performed a retrospective cohort study of all deliveries from 2016-2023 with documented zip-code & clinical/demographic data. FD status was assigned by zip-code of primary residence according to the U.S. Department of Agriculture (USDA) definitions. MMHD & SUD were identified using ICD-10 codes & clinical data. Kruskal-Wallis & Chi-square tests were performed to compare continuous & categorical variables, respectively. Poisson regressions, adjusted for relevant confounders, were used to estimate incidence risk ratios (IRR).
Among N=21,065 pregnancies, 7,160 (34.0%) lived in a FD. FDs had higher rates of Black/African American individuals (74% vs 54%, p< 0.001) and lower rates of White individuals (11.7% vs 19.3%, p< 0.001). Living in a FD was associated with higher rates of MMHD (11.5% vs 10.2%, p< 0.001) & SUD (6.7% vs 4.8%, p< 0.001). Controlling for maternal age, SUD & race determined that living in a FD was associated with a 1.1x higher risk for MMHD (IRR 1.1, 95% CI 1.01-1.20, p=0.02). Controlling for maternal age, MMHD & race, those in a FD had a 1.3-fold higher risk for SUD (IRR 1.3, 95% CI 1.2-1.5, p< 0.001).
Living in a FD is independently associated with an increased risk of MMHD and SUD. Our findings underscore the urgent need for public health strategies to address structural inequities in food access, housing and neighborhood conditions. Interventions targeting social determinants of health are essential to improving MMHD, advancing equity in perinatal care, and ultimately decreasing adverse pregnancy outcomes.