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A Spatial Approach to Examining Individual and Disparity-Level Factors and Hypertensive Disorders of Pregnancy

      Objective

      Investigate independent maternal and disparity-level factors contributing to hypertensive disorders of pregnancy, accounting for home address during pregnancy. The Area Deprivation Index (ADI), which is a ranked measure of neighborhood socioeconomic disadvantage that encompasses income, education, employment, and housing quality domains was used to assess disparity.

      Study Design

      A retrospective cohort study of Dane County, WI births (n=13,272) from 1/2016-6/2018 was used to explore effects of ADI (scale 1-10) and census block group on hypertensive disorders of pregnancy (HDP), excluding chronic hypertension. Models were adjusted for race/ethnicity, cigarette use, delivery route, pregnancy-related or chronic hypertension, pre-gestational and gestational diabetes, number of prenatal visits, maternal age, total weight gain, and pre-pregnancy BMI.

      Results

      We find evidence that higher ADI (OR 0.96, 95% CI 0.93 - 0.99, p 0.016) was protective against HDP. We find higher probabilities of HDP in the southern and eastern border census block groups and lower probabilities in the urban center of Madison, with the exception of one census block group, which had the lowest probability of HDP and corresponded to an ADI of 10 (high deprivation). The census block group with the highest probability of HDP was located in the SE corner of the county along the border in a more rural area of the county and corresponded to an ADI of 3 (low deprivation). Although specific blocks were notable, we find no evidence of an overall spatial trend in HDP (p: 0.178).

      Conclusion

      This approach demonstrates the importance of a holistic approach to health concerns during pregnancy. We anticipated ADI and race to be highly associated with HDP, which was not found in our analysis, highlighting that there are other factors driving these health outcomes. Geospatial analysis is a critical tool to elucidate the social determinants of health and design public health interventions.
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