(368) The Intersectionality of Social Determinants on Preterm Birth Risk

Thursday, January 30, 2025

10:30 AM – 12:30 PM

Submitting Author and Presenting Author(s)

Taylor Drazan, BA

Graduate Student
Indiana University - Bloomington
Indianapolis, Indiana, United States

Coauthor(s)

AC

Angela Campbell, PhD

Assistant Professor
Indiana University - Bloomington
Indianapolis, Indiana, United States
EF

Elissa Faro, PhD

Assistant Professor
University of Iowa
Iowa City, Iowa, United States
NS

Namrata Singh, MD

Assistant Professor
University of Washington
Seattle, Washington, United States
KR

Kelli K. Ryckman, PhD

Professor
Indiana University - Bloomington
Indianapolis, Indiana, United States

Objective: There is a significant gap in the understanding of what causes women with rheumatic disorders to be at increased risk for preterm birth (PTB). This study aimed to identify social determinants that influence the relationship between immune-mediated inflammatory arthritis (IMIA), including rheumatoid arthritis, psoriatic arthritis, and axial spondyloarthritis, and PTB in a large multi-racial/ethnic cohort of women. In line with the intersectionality framework, we quantified the relationship between IMIA and PTB and how it is impacted by race, insurance type, and mother’s age.

Study Design: We utilized data from electronic medical records from Indiana University Health curated by the Regenstrief Institute, Inc. on births from 2018 to 2022 to create a retrospective cohort of 72,264 unique deliveries. A stratified logistic regression analysis was conducted to assess the associations between maternal age, race, and insurance type with preterm birth, separately for women with and without IMIA. Interaction terms were included to explore the multiplicative effects of these variables.

Results: Among women with IMIA (n=294), Non-Hispanic (NH) Black women were at significantly increased risk of PTB (OR=1.50, p=0.006), and advanced maternal age (35-49yrs) was also associated with higher risk (OR=0.94, p=0.031). However, the interaction between age and NH Black women, though suggestive, did not reach statistical significance. For non-IMIA women (n=71,970), similar patterns were observed with significant associations for maternal age (OR=0.23, p< 0.001) and NH Black women (OR=0.19, p< 0.001). Importantly, the interaction between age and NH Black women was statistically significant (OR=0.32, p< 0.001), indicating that the combined effect of these factors may amplify PTB risk.

Conclusion:

These findings suggest intersectional factors, particularly race and maternal age, interact complexly to influence PTB irrespective of IMIA. Future exploration of intersectional identities and their impact on perinatal health is warranted.