Madden Nigel, Quan Irene Li, Feinglass Joe, Yee Lynn M
Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, the Program in Public Health, and the Division of General Internal Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois.
Obstet Gynecol. 2025 May 22;146(1):138-146. doi: 10.1097/AOG.0000000000005942.
To evaluate the association between patient-reported social needs and birth outcomes in a large cohort of pregnant people after implementation of a universal screening program.
We conducted a retrospective cohort evaluation of a quality-improvement initiative including 20,480 pregnant people who had social determinants of health screening during pregnancy between May 2021 and July 2023. The primary exposure was one or more patient-reported social needs. Multivariable models evaluated the association between reporting one or more social needs and maternal and neonatal birth outcomes, controlling for sociodemographic and clinical risk factors. A subgroup analysis examined these outcomes among individuals with Medicaid insurance.
Of 20,480 screened patients, 856 (4.2%) reported at least one social need during pregnancy. Among these patients who reported multiple needs, 21.1% reported transportation needs, 22.5% reported medication unaffordability, 27.2% reported food insecurity, 12.7% reported housing insecurity, and 33.8% reported mental health care needs. On adjusted analyses, reporting at least one social need was significantly associated with risk of severe maternal morbidity (adjusted incident rate ratio 1.55, 95% CI, 1.03-2.32) and low birth weight (adjusted incident rate ratio 1.34, 95% CI, 1.09-1.64). Among individuals with Medicaid insurance (n=4,671), 11.6% reported at least one social need, and the association with severe maternal morbidity (adjusted odds ratio [aOR] 1.83, 95% CI, 1.09-3.07) was greater. In addition, in patients with Medicaid insurance, reporting at least one social need was associated with more than twofold increased odds of preeclampsia (aOR 2.28, 95% CI, 1.16-4.50).
Patient-reported social needs were associated with adverse birth outcomes, particularly among pregnant people with Medicaid insurance. Findings underscore the potential importance of health system quality improvement and social care outreach initiatives to improve pregnancy-related health.
在实施一项通用筛查计划后，评估一大群孕妇中患者报告的社会需求与分娩结局之间的关联。
我们对一项质量改进计划进行了回顾性队列评估，该计划纳入了20480名在2021年5月至2023年7月期间孕期接受健康社会决定因素筛查的孕妇。主要暴露因素是一项或多项患者报告的社会需求。多变量模型评估了报告一项或多项社会需求与孕产妇及新生儿分娩结局之间的关联，并对社会人口统计学和临床风险因素进行了控制。亚组分析在有医疗补助保险的个体中研究了这些结局。
在20480名接受筛查的患者中，856名（4.2%）在孕期报告了至少一项社会需求。在这些报告了多项需求的患者中，21.1%报告了交通需求，22.5%报告了药物支付困难，27.2%报告了粮食不安全，12.7%报告了住房不安全，33.8%报告了心理健康护理需求。经校正分析，报告至少一项社会需求与严重孕产妇发病风险（校正发病率比1.55，95%可信区间，1.03 - 2.32）和低出生体重（校正发病率比1.34，95%可信区间，1.09 - 1.64）显著相关。在有医疗补助保险的个体（n = 4671）中，11.6%报告了至少一项社会需求，且与严重孕产妇发病的关联更强（校正比值比[aOR] 1.83，95%可信区间，1.09 - 3.07）。此外，在有医疗补助保险的患者中，报告至少一项社会需求与子痫前期的发病几率增加两倍以上相关（aOR 2.28，95%可信区间，1.16 - 4.50）。
患者报告的社会需求与不良分娩结局相关，尤其是在有医疗补助保险的孕妇中。研究结果强调了卫生系统质量改进和社会护理推广举措对改善妊娠相关健康的潜在重要性。
