Adverse Pregnancy Outcomes and Health-Related Social Needs Among Parous Women

Adverse pregnancy outcomes (APOs) are associated with increased risk for postpartum complications, adverse outcomes in future pregnancies, and chronic disease. Health-related social needs (HRSNs), the social and economic factors of health, affect long-term outcomes through mechanisms such as health behaviors, ability to maintain well-being, and barriers to care.

To investigate whether APOs are associated with HRSNs among parous Black and/or Latina women.

This cross-sectional study analyzed data from the BUSY-BP cohort study, which recruited Black and/or Latina women aged 18 to 65 years between February 2023 and April 2024 at a large integrated health system in New England. BUSY-BP study participants completed the Centers for Medicare and Medicaid Services Accountable Health Communities HRSN Screening Tool, which assesses burden of HRSNs across 13 domains. The present study included participants who were parous and had complete covariate data through convenience sampling. Statistical analyses were conducted from March 2024 to July 2025.

APOs self-reported by participants at enrollment included hypertensive disorders of pregnancy, gestational diabetes, preterm birth, and/or low birth weight.

The primary outcome was high burden of HRSNs, defined as a composite score of 7 or more domains of need. Secondary outcomes were individual domains of HRSNs (living situation, food, transportation, utilities, safety, financial strain, employment, family and community support, education, exercise, substance use, mental health, and disabilities). Logistic regression was used to test the association between APOs and HRSNs, adjusting for age, years since last pregnancy, and parity.

Among the 883 participants included (median [IQR] age, 39.2 [14.6] years; 594 with Black race [67.3%], 442 with Latina ethnicity [50.1%], 289 [32.7%] with other race, 441 [49.9%] with other ethnicity), 400 (45.3%) reported experiencing 1 or more APOs (175 hypertensive disorders of pregnancy [19.8%], 109 gestational diabetes [12.3%], 157 low birth weight [17.8%], 226 preterm birth [25.6%]). Prevalence of APOs increased with higher cumulative burden of HRSNs. Compared with no APO history, any APO history was associated with higher adjusted odds of high HRSN burden (adjusted OR [AOR], 1.68; 95% CI, 1.22-2.32; P = .001). There was a dose-response association between the number of different APO types and HRSN burden (AOR, 1.39 [95% CI, 1.19-1.62] per additional APO type; P < .001). Among individual domains of HRSNs, education had an association with APOs that had the greatest magnitude (AOR, 1.81; 95% CI, 1.19-2.79).

In this cross-sectional study, APOs were associated with a greater burden of HRSNs among Black and/or Latina women. This finding highlights that APOs provide a critical opportunity to deploy interventions to address both medical and social factors associated with adverse health outcomes.