Maternal social deprivation and risk of preeclampsia

AbstractObjectivesWe examined the use of an indicator of the cumulative effect of multiple community-level risk factors on risk of preeclampsia, a morbid maternal hypertensive disorder.Study designThis was a retrospective cohort study of 41,834 singleton pregnancies from four urban hospitals.Main outcome measuresWe used the social deprivation index (SDI), which is a composite of seven neighborhood demographic characteristics collected by the American Community Survey. SDI quartile 1 (Q1) is the least deprived area and Q4 is the most deprived. A modified Poisson regression model with robust error variance was used to calculate the relative risk (RR) and 95% confidence interval for the association between SDI quartiles (using Q1 as a reference) and preeclampsia. Preeclampsia subtypes were examined as secondary outcomes (term preeclampsia and preterm preeclampsia). Models were adjusted for maternal age, education, insurance, chronic health diseases, tobacco use, and gravidity.ResultsOverall, 8.7% of our population had a preeclampsia diagnosis. Majority of the population was Hispanic, had lower education levels, and were on public insurance. Those living in the highest quartile of social deprivation had increased risk of preeclampsia (RR 1.25, 95% CI 1.15–1.35). However, results were null after adjustments. In contrast, living in the highest quartile of social deprivation was associated with increased risk of preterm preeclampsia, even after adjustments (RR 1.26, 95% CI 1.05–1.50).ConclusionUsing electronic health records, the SDI may be an easily calculable measure to identify patients at risk for the preterm preeclampsia subtype.