(1091) Patient-reported unmet health-related social needs in patients with and without preterm birth

Preterm birth (PTB) is the leading cause of infant mortality and has been linked to social determinants of health (SDOH) such as economic stability, social and community context, and limited healthcare access. There is little evidence on the impact of unmet health-related social needs (HRSNs), the patient-level manifestations of these SDOH, on birth outcomes. We sought to characterize the impact of patient-reported HRSNs on PTB.

Study Design:

Retrospective cohort study of pregnant patients who completed a screen at least once in pregnancy for HRSNs in a regional health-care system from 5/2020 to 3/2024. HRSNs in the domains of education, employment, family care, food, housing, medication affordability, transportation, and household utilities affordability were identified through a validated screening tool. The primary outcome was birth before 37 weeks’ gestation. Generalized estimating equations were generated to determine adjusted odds ratios (aOR) for the association between preterm birth and HRSN domains. Models were adjusted for advanced maternal age, nulliparity, hypertensive disorders of pregnancy, pre-existing diabetes mellitus, and pregravid body mass index.

Results:

There were 2,055 pregnancies screened for HRSNs that met inclusion criteria, of whom 156 (7.6%) had a PTB. Patients with a PTB were significantly more likely to report food insecurity (14.1% vs 8.2%; aOR 2.09 95% CI 1.22-3.59) and unemployment (19.2% vs 11.2%; aOR 1.74 95%CI 1.07-2.81). The presence of ≥ 2 or ≥ 3 HRSNs was associated with increased odds of PTB: ≥ 2 HRSNs aOR 1.68 (95% CI 1.12-2.52); ≥ 3 HRSNs aOR 1.81 (95% CI 1.11- 2.95). Other HRSNs represented in the cohort were not significantly associated with risk of PTB.

Conclusion:

Patient-reported food insecurity and unemployment are independently associated with PTB. Further, HRSNs in 2 or more of any domains have nearly the same impact. Future research is needed to understand the mechanisms of these associations to inform critically needed patient and policy level interventions to reduce PTB.