The Association of Social Vulnerability With Maternal and Fetal Outcomes in a Cardio-Obstetrics Cohort

Adverse social determinants of health are associated with poor pregnancy outcomes; however, data in cardio-obstetrics populations remain limited.

We aimed to define the burden of social vulnerability in a referral cardio-obstetrics population and evaluate the association and predictive performance of the Centers for Disease Control and Prevention's Social Vulnerability Index (SVI) for adverse maternal and fetal outcomes.

We conducted a cross-sectional study of all consecutive patients referred to our cardio-obstetrics program from March 2023 to January 2025. Social vulnerability was assessed by Centers for Disease Control and Prevention's SVI based on residential zip codes stratified into tertiles. Multivariable regression was conducted to examine the risk of maternal and fetal outcomes by SVI. Receiver operator characteristics analysis was performed to assess predictive ability of SVI summarized as area under the curve.

A total of 489 individuals were included. The overall median SVI of the referral cohort was 0.833. Increasing SVI was associated with younger age, higher BMI, Black race, and Medicaid insurance. The mean SVI was higher among patients with late entry to cardio-obstetrical care, neonatal intensive care unit admission, and fetal demise (P = 0.03, P = 0.04, and P < 0.001, respectively). In unadjusted regression analyses, delayed cardio-obstetrical care was associated with high SVI. SVI was not independently associated with most maternal and fetal outcomes in multivariable adjusted analyses. The discriminatory performance of SVI was highest for fetal/neonatal demise (area under the curve: 0.80; 95% CI: 0.68-0.92).

The cardio-obstetric referral population exhibited a high overall SVI. Higher social vulnerability was associated with delayed access to care but not independently associated with most adverse maternal and fetal pregnancy outcomes.