Association Between Patient-Reported Social Needs and Birth Outcomes After Implementation of Universal Screening

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.