(1175) Association of Prior Adverse Pregnancy Outcomes with Health-Related Social Needs: The BUSY-BP Study

Objective:
Adverse pregnancy outcomes (APOs) are associated with increased risk for postpartum complications, future APOs, and chronic disease, highlighting the importance of follow-up care. However, health-related social needs (HRSNs) – the social and economic needs that influence health – can pose barriers to accessing care. Here, we investigated whether APOs, including hypertensive disorders of pregnancy (HDP), gestational diabetes (GDM), preterm birth (PTB, < 37 weeks), or low birthweight (LBW, < 2.5 kg), are associated with HRSNs.

Study Design:
We included parous participants in the BUSY-BP study of Black and/or Latina women aged 18-65 years. Participants completed the Centers for Medicare and Medicaid Services Accountable Health Communities screening tool, which assesses 13 domains of HRSNs (Table 1). Cumulative burden of HRSNs was calculated as the sum of domains of need for each participant (range 0-13). The primary exposure was any prior APO, and the primary outcome was a composite HRSN score ≥7 (top quartile of HRSN scores). Logistic regression tested the association of APO history with HRSNs, adjusted for age, years since last pregnancy, and parity. 

Results:
Among 1,231 participants (mean [SD] age 40.1 [10.7] years, 794 [64.5%] Black, 642 [52.2%] Latina),  521 (42.3%) reported ≥1 previous APO (219 [17.8%] HDP, 149 [12.1%] GDM, 195 [15.8%] LBW, 288 [23.4%] PTB). Prevalence of prior APOs increased with a higher cumulative burden of HRSNs (Figure 1). Compared with no previous APOs, history of APOs was associated with 1.67-fold odds of a high HRSN score (i.e., ≥7 domains of need; adjusted OR 1.67, 95% CI 1.22-2.31, P=0.002). Educational needs were most strongly associated with prior APOs, and among APOs, HDP and GDM were associated with the greatest number of HRSNs (Table 1).

Conclusion:
APO history was associated with greater burden of HRSNs, highlighting APO occurrence as a potential opportunity for intervention to address both medical and social factors associated with adverse health outcomes.