SEARCHCOHORTobstetrics and gynecology, public health

cohort·obstetrics and gynecology, public health, epidemiology, internal medicine·PMC10200035

Influence of the COVID-19 pandemic on social determinants of health among an inner-city obstetrical population

AJOG Global Reports · 6 authors, 4 centres

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TL;DR

This study compared social determinants of health in a cohort of 577 pregnant patients who delivered before versus during the COVID-19 pandemic. It found that pandemic-period delivery was associated with higher risks of limited social support and race-based discrimination, but with fewer delayed prenatal care visits and less use of federally funded programs.

Full summary

924 CHARS

This was a secondary analysis of a prospective cohort study involving 577 postpartum patients at a single inner-city academic medical center. The study compared social determinants of health (SDoH) between patients who delivered before March 30, 2020 (n=452) and those who delivered on or after that date (n=125). The central results showed that delivering during the pandemic was associated with a higher relative risk of reporting limited social or emotional support (RR, 1.62) and race-based discrimination (RR, 1.59). Conversely, the pandemic group was less likely to use federally funded programs and reported less limited access to transportation. The study is limited by potential social-desirability bias and missing data, and its findings may not be generalizable beyond the urban population studied. The implications highlight the need to focus on social supports that were negatively impacted during the pandemic.

STUDY TYPE

cohort

SPECIALTY

obstetrics and gynecology

SUMMARISED BY

AI pipeline

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100% · A

ORIGINAL PAPER

PMC10200035

Influence of the COVID-19 pandemic on social determinants of health among an inner-city obstetrical population

AJOG Global Reports

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ABSTRACT

Abstract BACKGROUND Social determinants of health are a well-described influencer of pregnancy-related morbidity and mortality. It is unclear how societal changes secondary to the COVID-19 pandemic altered the social determinants of health among pregnant patients. OBJECTIVE This study aimed to investigate differences in the social determinants of health among patients who experienced pregnancy before and during the COVID-19 pandemic. STUDY DESIGN This was a secondary analysis of an ongoing prospective cohort study examining the social determinants of health in postpartum patients at a single inner-city academic medical center. The planned secondary analysis was to compare the social determinants of health between patients that experienced societal changes before the pandemic and patients that experienced societal changes during the pandemic. Patients were included in the pandemic group if they delivered on or after March 30, 2020; moreover, patients in the pandemic group were compared with those who delivered before March 30, 2020 (referent group). Medical records were used to collect sociodemographic, pregnancy, and infant outcome data. The study participants were interviewed to collect detailed information regarding their perceived social, emotional, and physical environment as indicators of social determinants of health. Generalized linear modeling estimated the influence of social determinants of health  on births during the COVID-19 pandemic. RESULTS Overall, 577 patients were enrolled in the study, of which 452 (78%) delivered before the COVID-19 pandemic and 125 (22%) delivered during the pandemic. Patients who delivered during the pandemic were more likely to report limited social or emotional support (relative risk, 1.62; 95% confidence interval, 1.02–2.59) and higher race-based discrimination (relative risk, 1.59; 95% confidence interval, 1.00–2.53). Mothers in the prepandemic group were more likely to have used federally funded programs, such as Medicaid, food stamps, and the Special Supplemental Nutrition Program for Women, Infants, and Children, during their pregnancy. Furthermore, the referent group reported more limited access to transportation. In addition, mothers in the prepandemic group were more likely to initiate prenatal care at a later gestational age and have fewer total prenatal care visits. CONCLUSION The COVID-19 pandemic created unprecedented changes in pregnancy care, and these were reflected in social determinants of health. It is imperative that we focus on the social determinants of health that were mitigated during this time and their effects on maternal and infant health. Key words: access to care, healthcare equity, perinatal morbidity, racism, safety, social determinants of health, transportation

CITATION EXPORT

Leah M Hefelfinger, Emily A DeFranco, Christina Mendez et al.. Influence of the COVID-19 pandemic on social determinants of health among an inner-city obstetrical population. AJOG Global Reports. (2023). https://doi.org/10.1016/j.xagr.2023.100225

AUTHORS

6 · 4 CENTRES

Leah M Hefelfinger, Emily A DeFranco, Christina Mendez, Katy McFarland, Elizabeth Kelly, Braxton Forde

1University of Cincinnati College of Medicine, Cincinnati, OH (Mses Hefelfinger, Mendez, and McFarland)
2Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Cincinnati College of Medicine, Cincinnati, OH (Drs DeFranco and Forde)
3Department of Obstetrics and Gynecology, University of Cincinnati College of Medicine, Cincinnati, OH (Dr Kelly)
4Fetal Care Center, Cincinnati Children's Hospital Medical Center, Cincinnati, OH (Dr Forde)