(948) Neighborhood Deprivation Associated with Extremely Preterm Birth during COVID-19 Pandemic

Area Deprivation Index (ADI) is strongly associated with obstetric outcomes but understudied during the COVID-19 pandemic. We sought to evaluate the relationship between ADI and preterm birth during the early pandemic.

Study Design:

We performed a secondary analysis of a prospective longitudinal cohort study investigating the impact of COVID-19 exposure in pregnancy on perinatal outcomes. Pregnant patients were recruited 12/23/20-7/18/22 and serially tested with serum antibody testing for COVID-19 exposure during pregnancy. Delivery residence address was used to categorize patients into low ADI (≤ 50^th percentile) and high ADI (≥ 75^th percentile, indicating high level of deprivation) groups. The primary outcome was preterm birth, using multivariable regression and stratified by gestational age at birth; secondary outcomes included other perinatal complications.

Results:

306 patients were included. Overall, preterm birth rates did not differ between high and low ADI groups; however, low ADI was significantly associated with lower rates of extreme preterm birth < 28 weeks and < 34 weeks (Table 1). After adjusting for obesity and tobacco use, the association persisted at < 28 weeks (aOR 0.26, 95% CI 0.07-0.73) and < 34 weeks (aOR 0.35 95% CI 95% 0.14-0.87; Table 2). There were no other differences found in perinatal outcomes except for a higher rate of neonatal intracranial hemorrhage in the low ADI group (3.2% vs 0%, p=0.03).

Conclusion: High ADI was associated with increased risk of extremely preterm birth during the early COVID-19 pandemic even when controlling for obesity and tobacco use. The interplay of social determinants of health and preterm birth must be better studied to target interventions to modifiable risk factors.