Association Between Social Vulnerability and Achieving Glycemic Control Among Pregnant Individuals With
Kartik K Venkatesh1, Katherine Germann, Joshua Joseph
1Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, the College of Medicine, the Division of Endocrinology, Department of Medicine, and the Department of Bioinformatics, The Ohio State University, Columbus, Ohio.
Obstetrics and Gynecology
|June 8, 2022
Summary
Pregnant individuals with pregestational diabetes living in socially vulnerable areas had lower rates of achieving glycemic control (HbA1c levels). Addressing social determinants of health is crucial for improving outcomes in pregnancy.
Area of Science:
- Reproductive Medicine
- Endocrinology
- Public Health
Background:
- Glycemic control in pregnancy is crucial for maternal and infant outcomes.
- Social vulnerability may impact health behaviors and access to care, potentially affecting glycemic control.
- Previous research has not extensively explored the link between community-level social vulnerability and glycemic control in pregestational diabetes during pregnancy.
Purpose of the Study:
- To evaluate the association between community-level social vulnerability and achieving glycemic control among individuals with pregestational diabetes.
- To determine if higher Social Vulnerability Index (SVI) scores correlate with poorer glycemic control (HbA1c levels).
Main Methods:
- Retrospective cohort study of 418 individuals with pregestational diabetes from 2012-2016.
- Addresses were geocoded and linked to the CDC's 2018 Social Vulnerability Index (SVI) at the census tract level.
- Multivariable Poisson regression was used to assess the association between SVI score and target HbA1c levels (<6.0% and <6.5%) in the second or third trimesters.
Main Results:
- 41.4% achieved HbA1c <6.0% and 56.7% achieved HbA1c <6.5%.
- Higher SVI scores were associated with a significantly lower likelihood of achieving target HbA1c levels.
- Each 0.1-unit increase in SVI score decreased the risk of achieving HbA1c <6.0% by nearly 50% (aRR 0.53) and HbA1c <6.5% by over 30% (aOR 0.67).
- Socioeconomic status and household composition/disability domains of SVI were particularly associated with poorer glycemic control.
Conclusions:
- Pregnant individuals with pregestational diabetes residing in areas of higher social vulnerability are less likely to achieve adequate glycemic control.
- These findings highlight the impact of social determinants of health on pregnancy outcomes.
- Interventions targeting social determinants are needed to improve glycemic control in this population.
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