**Background:** Social determinants of health (SDoH) are well-known drivers of pregnancy-related morbidity and mortality. The COVID-19 pandemic caused widespread societal changes, but it was unclear how these changes affected SDoH among pregnant patients. This study aimed to investigate differences in SDoH between patients who experienced pregnancy before and during the pandemic.
**Methods:** This was a secondary analysis of an ongoing prospective cohort study conducted at the University of Cincinnati Medical Center from 2011 to 2022. A total of 577 postpartum patients were enrolled. Patients were categorized into a pandemic group (delivery on or after March 30, 2020; n=125) and a referent group (delivery before March 30, 2020; n=452). Data were collected via medical records and a standardized 192-question survey covering physical environment, social environment, health behaviors, healthcare, and structural drivers. Primary outcomes were SDoH indicators including living conditions, social support, joy/resilience, healthcare coverage, healthcare utilization, intimate partner violence, and discrimination. Generalized linear modeling estimated relative risks (RR) for SDoH associated with pandemic births. No adjustment was made for confounders due to overlap among SDoH factors.
**Key Results:** Baseline characteristics differed between groups: the pandemic group had a higher mean maternal age (28.7 vs 26.2 years, p<0.01), a higher proportion of Hispanic mothers (16.8% vs 3.6%, p<0.01), and a lower proportion of non-Hispanic Black mothers (36.8% vs 53.2%, p<0.01). Household income was higher in the pandemic group (63.8% vs 80.6% with income <$40,000, p<0.01).
Regarding SDoH, the pandemic group was significantly more likely to report limited social or emotional support (17.7% vs 10.9%; RR 1.62, 95% CI 1.02–2.59) and race-based discrimination (18.0% vs 11.3%; RR 1.59, 95% CI 1.00–2.53). Conversely, the pandemic group had significantly lower rates of limited transportation (15.2% vs 36.7%; RR 0.41, 95% CI 0.27–0.64), delayed prenatal care after 14 weeks (22.9% vs 36.9%; RR 0.62, 95% CI 0.44–0.88), and use of federally funded programs: Medicaid (46.4% vs 64.8%; RR 0.72, 95% CI 0.59–0.87), food stamps (28.8% vs 54.2%; RR 0.53, 95% CI 0.40–0.71), and WIC (47.2% vs 64.6%; RR 0.73, 95% CI 0.60–0.89). No significant differences were found for large household size, shelter living, utilities shut off, feeling unsafe, joy/happiness, intimate partner violence, or limited prenatal care (<5 visits).
PREGNANCY CHARACTERISTICS ALSO DIFFERED
the pandemic group had earlier gestational age at first ultrasound (12.9 vs 15.3 weeks, p<0.01) and more total prenatal care visits (median 12 vs 10, p<0.01). Newborn outcomes (birthweight, gestational age at delivery, Apgar scores, abnormal conditions, congenital anomalies) were similar between groups.
**Clinical Implications:** The pandemic was associated with both positive and negative changes in SDoH. While patients had improved access to transportation and earlier prenatal care, they experienced increased social isolation and discrimination. The reduction in use of federally funded programs may reflect increased employment and income, but could also indicate barriers to enrollment. The rise in reported racism is particularly concerning and may have mental health implications. These findings underscore the need for interventions that address both healthcare access and the broader social and emotional support systems for pregnant patients, especially during public health crises.