(940) Neighborhood-level exposure to gun violence and adverse pregnancy outcomes

Objective:
Adverse pregnancy outcomes are associated with prenatal stress. This study examined whether prenatal exposure to neighborhood-level gun violence was associated with increased risk of adverse outcomes in a cohort of New York pregnant people.

Study Design:
This was a retrospective study of all pregnant patients delivering at a single institution in New York City from January 1, 2013 through December 31, 2022. We excluded patients residing outside New York state. Electronic medical records were assessed for clinical and demographic data. Addresses were matched to 2020 US Census tracts and merged with data from The Gun Violence Archive (a validated national repository) to compute the number of gun violence incidents in each tract during each pregnancy.  We then transformed these into rates (person-years). Patients were categorized as 1) any prenatal gun violence exposure, and 2) low, medium, or high exposure using Jenks natural breaks. Multivariable logistic regression models controlling for social indices examined associations of exposure with adverse pregnancy outcomes.

Results:
We included 52,906 pregnant patients. 1,367 (2.58%) patients were exposed to ≥1 gun violence incident during their pregnancy. When classified into risk tertiles, 51,617 (97.56%) had low exposure, 1,105 (2.09%) had medium exposure, and 184 (0.35%) had high exposure. Patients with greater gun violence exposure were younger, nulliparous, non-White, had public insurance, and had an obese pre-pregnancy BMI (Table 1). In multivariable models, patients with high compared with low gun violence exposure were at greater risk for hypertensive disorders of pregnancy (OR 1.82 [1.15, 2.88]) and placental abruption (OR 4.18 [1.15, 10.75]). Although patients with gun violence exposure delivered at earlier gestational ages (p < 0.001, Table 1), preterm birth was not significantly associated with exposure to gun violence (Table 2).

Conclusion:
Neighborhood-level gun violence exposure during pregnancy was associated with greater risk of hypertensive disorders of pregnancy and placental abruption.