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Clinical Obstetrics

Poster Session 2

(614) Childhood Opportunity Index and Severe Morbidity in a cohort complicated by Placenta Accreta Spectrum Disorder

Tuesday, February 13, 2024
3:30 PM – 5:00 PM  
Location: Prince George's Exhibit Hall CDE, Lower Atrium Level
Objective: The objective of this study was to evaluate the association of the Childhood Opportunity Index (COI) with severe maternal and neonatal morbidity in a sample of cases complicated by Placenta Accreta Spectrum (PAS) in New York City (NYC). COI is a complex measure evaluating social and built environment regarding individual capacity for development.

Study Design: This was a multicenter retrospective cohort study of histopathologically confirmed PAS cases between 1/1/2013 - 6/30/2022 at three NYC institutions. Subjects were assigned a COI value ranging from 0 to 1 based on their home zip code. Primary outcomes were composite maternal and neonatal morbidity. Outcomes were analyzed using logistic regression. Multivariate models adjusted for age, body mass index (BMI), race, ethnicity, insurance type, use of assisted reproductive technology, history of prior cesarean section, prior myomectomy, prior dilation & curettage, smoking, placental location, grade of placental invasion, presence of inter-disciplinary meeting, and delivering institution. Covariates were retained if p < 0.10.

Results: 291 cases were included in these analyses. Logistic regressions were used to examine correlations between COI and severe morbidity. In univariate models, several maternal morbidity outcomes were significantly associated with COI. In the multivariate regression, mechanical ventilation’s association with COI was still significant (p < 0.01). Regarding neonatal morbidity, only intraventricular hemorrhage had statistical significance in its association with COI (OR=0.98, CI 95%=0.96, 1.00).

Conclusion: These results suggest that socioenvironmental factors influence health outcomes through complex pathways in cases of severe morbidity. Different components of the composite outcomes correlated differently with COI values, suggesting that COI alone is insufficient to predict impact of social determinants of health on in morbidity. Further research exploring the intersections of socioenvironmental and clinical factors must be conducted.