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Health Equity/Community Health

Poster Session 3

(697) Social determinants of health and hypertensive disorders of pregnancy in patients with heart disease

Wednesday, February 14, 2024
8:30 AM – 10:00 AM  
Location: Prince George's Exhibit Hall CDE, Lower Atrium Level
Objective: Hypertensive disorders of pregnancy (HDP) are a leading cause of maternal morbidity and mortality in the United States (US). We sought to examine the relationship between social determinants of health (SDOH) and HDP in patients with congenital or acquired maternal cardiac disease (MCD).

Study Design: Retrospective cohort study of 156 MCD patients from 2015- 2019 at a single tertiary center. Patients with ≥1 visit in the cardio-obstetrics program and delivered at this center were included. The primary exposure was SDOH defined as a census tract level Area Deprivation Index (ADI) using a scale of 1 – 100 with social disadvantage worsening as numbers increase. ADI was divided into categories as follows: Low (0-33), Medium (34-66), High (67-100). The primary outcome was a composite of gestational hypertension, preeclampsia with and without severe features, HELLP syndrome, and eclampsia; secondarily, individual components of this composite were examined. Differences in outcomes were compared across ADI categories. A ROC curve and AUC examined the predictive ability of ADI.

Results: On average, patients were obese (BMI 32.1±8.8), non-Hispanic White (55%), ≥ mWHO Class II (87%), publicly/self-insured (61%), and 15% had chronic hypertension. Baseline characteristics across categories differed with respect to age, race, marital status, and payor. Delivery gestational age was no different (mean 37.0±3.3 weeks), and overall, 29.5% developed HDP. An increasing rate of HDP as ADI category increased was observed; however, the primary composite was not statistically significant between categories (Low: 18.8%, Medium: 22%, High: 34.3%; p= 0.21, Table 1). Additionally, no component of the HDP composite showed significance. ADI as a continuous variable was not predictive of HDP (AUC=0.5).

Conclusion: Nearly 1 in 3 patients in our cardio-obstetrics cohort developed HDP. HDP rates appeared to increase as SDOH worsened. While this was not significant, it should be further explored in a larger geographically and racially diverse sample.