(386) Neighborhood Deprivation Impacted COVID-19 Vaccination and Infection Rates Among Pregnant Patients

Objective: 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 COVID-19 outcomes among pregnant patients 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. Patients were recruited if they were pregnant between 12/23/20-7/18/22 and serially evaluated for exposure to SARS-CoV-2 infection using serum antibody testing throughout pregnancy. Address of residence at time of delivery was used to categorize patients into a low ADI group (≤ 50^th percentile, indicating low levels of deprivation) and a high ADI group (≥ 75^th percentile, indicating high levels of deprivation). Our primary outcome was COVID-19 vaccination and infection during pregnancy.

Results: 306 patients were included. Those with higher ADI were younger (28 vs 32, p< 0.01), were less likely to be nulliparous (18% vs 38%, p=0.02), had a higher average body mass index (35 vs 28, p=0.01), and had higher rates of tobacco use (7% vs 2%, p=0.03), asthma (17% vs 9%, p< 0.01), and depression (21% vs 17%, p=0.01). There were notable differences in insurance type, race, and household income between groups (Table 1). Importantly, the high ADI group was less likely to receive COVID-19 vaccination (24.2% vs 54%, p< 0.01), more likely to develop SARS-CoV-2 infection (59.3% vs 41.9%, p< 0.01), and more likely to be hospitalized due to COVID-19 (3.9% vs 0%, p=0.04, Table 2).

Conclusion: ADI differences were associated with vaccine hesitancy and COVID-19 infection and severity. Overall, these findings highlight the complex interplay of factors impacting perinatal outcomes during the COVID-19 pandemic, leading to two disparate perinatal experiences. Modifiable characteristics for both individuals and communities–such as tobacco use, obesity, and lack of vaccination–could serve as targets for interventions to improve perinatal outcomes.