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Fetus

Poster Session 2

(471) Association of neighborhood socioeconomic disadvantage and stillbirth

Tuesday, February 13, 2024
3:30 PM – 5:00 PM  
Location: Prince George's Exhibit Hall CDE, Lower Atrium Level
Foundation Awardee
Objective:

Individual measures of adverse social determinants of health (SDOH) are associated with an increased risk of stillbirth, but whether community-level measures are associated with this risk is uncertain. We examined whether neighborhood socioeconomic disadvantage, as measured by the Area Deprivation Index (ADI), is associated with risk of stillbirth.

Study Design:

In this secondary analysis from the prospective cohort Nulliparous Pregnancy Outcomes Study: Monitoring Mothers-To-Be study, participant home addresses at enrollment were geocoded at the census tract level and linked to the 2015 ADI. The ADI score incorporates the domains of income, education, employment, and housing quality into a composite national US ranking of neighborhood socioeconomic disadvantage, and was analyzed in tertiles from the lowest (tertile 1 [T1], least disadvantaged, reference) to the highest (T3, most disadvantaged) score. The outcome was stillbirth, defined as intrauterine fetal demise ≥20 weeks. Poisson regression with robust error variance was used to estimate an adjusted relative risk (aRR) and incorporated individual-level covariates including age at delivery, pre-pregnancy body mass index, chronic hypertension, and diabetes.

Results:

Of 9,588 enrolled pregnant individuals with available ADI data, 47 had stillbirths (38 antepartum; 9 intrapartum). The frequency of stillbirth increased with neighborhood deprivation, from 4 per 1,000 individuals in T1 (i.e., least disadvantaged) to 9 per 1,000 individuals in T3 (i.e., most disadvantaged) (p < 0.01). Pregnant individuals living in the most disadvantaged neighborhoods (T3) were more likely to experience a stillbirth compared to those living in the least disadvantaged neighborhoods (T1) (aRR: 2.15; 95% CI: 1.03 to 4.48). Those in an intermediate tertile (T2) of neighborhood disadvantage were not more likely to experience a stillbirth.

Conclusion:

Nulliparous pregnant individuals who lived in the most disadvantaged U.S. neighborhoods were at increased risk of stillbirth.