(225) A polysocial risk and primary cesarean delivery

A secondary analysis of data from the prospective Nulliparous Pregnancy Outcomes Study: Monitoring Mothers-To-Be observational cohort. A total of 19 individual and neighborhood-level SDOH factors conceptualized per 2030 Healthy People Domains were measured in early pregnancy. The outcome was CD. Sparse Principal Components Analysis was used to develop a polysocial risk score. Modified Poisson regression was used to determine the association between this polysocial risk score and CD as both a continuous measure and categorized into tertiles after adjustment for age, body mass index, chronic hypertension, and pregestational diabetes. Model discrimination per the c-statistic was done to assess the capability of the polysocial risk score to predict CD.

Results:
Among 9,012 eligible individuals, 24% experienced a CD. Those who had a CD were generally more likely to experience adverse SDOH factors. Among 19 candidate SDOH factors (6 neighborhood- and 13 individual-level), the polysocial risk score included a total of 11 variables using Sparse Principal Components Analysis for variable selection (Figure). In adjusted analyses, a higher polysocial risk score, whether evaluated as a continuous measure (aOR: 1.63; 95% CI: 1.35, 1.98) or after categorization in tertiles (T2 vs. T1: 40.9% vs. 26.1%; aRR: 1.35; 95% CI: 1.19, 1.53; and T3 vs. T1: 33.1% vs. 26.1%; aRR: 1.44; 95% CI: 1.25, 1.66) was associated with CD. The polysocial risk score provided satisfactory discrimination with a c-statistic of 0.68 (95% CI: 0.662, 0.688).

Conclusion:
A polysocial risk score was associated with an increased risk of CD among individuals who delivered term singletons in the vertex presentation.