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Association Between Patient-Reported Social Needs and Birth Outcomes After Implementation of Universal Screening
Nigel Madden1, Irene Li Quan, Joe Feinglass
1Division 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.
Obstetrics and Gynecology
|May 22, 2025
Summary
Patient-reported social needs, such as food insecurity and housing instability, are linked to adverse birth outcomes. These associations are stronger for pregnant individuals with Medicaid insurance, highlighting the need for social care interventions.
Area of Science:
- Obstetrics and Gynecology
- Public Health
- Health Services Research
Background:
- Universal screening for social determinants of health (SDOH) is increasingly implemented in prenatal care.
- Understanding the impact of patient-reported social needs on birth outcomes is crucial for targeted interventions.
- Previous research has not fully elucidated these associations in the context of universal screening programs.
Purpose of the Study:
- To evaluate the association between patient-reported social needs and birth outcomes.
- To assess if these associations differ among pregnant individuals with Medicaid insurance.
- To inform quality improvement initiatives in maternal healthcare.
Main Methods:
- Retrospective cohort study of 20,480 pregnant individuals screened for social needs.
- Analysis of patient-reported social needs (transportation, medication affordability, food insecurity, housing insecurity, mental health care needs).
- Multivariable models controlling for sociodemographic and clinical factors; subgroup analysis for Medicaid recipients.
Main Results:
- 4.2% of patients reported at least one social need.
- Social needs were associated with increased risk of severe maternal morbidity and low birth weight.
- Among Medicaid recipients, social needs showed a greater association with severe maternal morbidity and preeclampsia.
Conclusions:
- Patient-reported social needs are significantly associated with adverse birth outcomes.
- Pregnant individuals with Medicaid insurance experience amplified risks.
- Health system quality improvement and social care outreach are vital for improving pregnancy-related health.
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