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Am J Perinatol 2023; 40(13): 1383-1389
DOI: 10.1055/s-0043-1770162
SMFM Fellowship Series Article

A Retrospective Review of Social Deprivation Index and Maternal Outcomes with Placenta Accreta Spectrum from a Single Referral Center

Alison N. Goulding 
1   Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, Texas
,
Karin A. Fox
1   Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, Texas
,
Christina C. Reed
1   Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, Texas
,
Bahram Salmanian
1   Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, Texas
,
Alireza A. Shamshirsaz
1   Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, Texas
,
Kjersti M. Aagaard
1   Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, Texas
› Author Affiliations Funding This research was supported in part by NICHD grant no.: R01HD091731 (PI K.M. Aagaard) and NICHD grant no.: R01HD094347–04 (PI A.V. Annapragada).
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Abstract

Objective Little is known about how community characteristics influence placenta accreta spectrum (PAS) outcomes. Our objective was to evaluate whether adverse maternal outcomes among pregnant people (gravidae) with PAS delivering at a single referral center differ by community-level measures of social deprivation.

Study Design We conducted a retrospective cohort study of singleton gravidae with histopathology confirmed PAS delivering from January 2011 to June 2021 at a referral center. Data abstraction collected relevant patient information, including resident zip code, which was linked to Social Deprivation Index (SDI) score (a measure of area-level social deprivation). SDI scores were divided into quartiles for analysis. Primary outcome was a composite of maternal adverse outcomes. Bivariate analyses and multivariable logistic regression were performed.

Results Among our cohort (n = 264), those in the lowest (least deprived) SDI quartile were older, had lower body mass index, and were more likely to identify as non-Hispanic white. Composite maternal adverse outcome occurred in 81 (30.7%), and did not differ significantly by SDI quartile. Intraoperative transfusion of ≥4 red blood cell units occurred more often among those living in deprived areas (31.2% in the highest [most deprived] vs. 22.7% in the lowest [least deprived] SDI quartile, p = 0.04). No other outcomes differed by SDI quartile. In multivariable logistic regression, a quartile increase in SDI was associated with 32% increased odds of transfusion of ≥4 red blood cell units (adjusted odds ratio: 1.32, 95% confidence interval: 1.01–1.75).

Conclusion Within a cohort of gravidae with PAS delivered at a single referral center, we found that those living in more socially deprived communities were more likely to receive transfusion of ≥4 red blood cell units, but other maternal adverse outcomes did not differ. Our findings highlight the importance of considering how characteristics of the surrounding community can impact PAS outcomes and may assist with risk stratification and resource deployment.

Key Points

  • Little is known about how community characteristics influence PAS outcomes.

  • In a referral center, transfusion was more common in gravidae living in socially deprived areas.

  • Future research should consider how community characteristics can impact PAS outcomes.

Keywords

placenta accreta spectrum - social determinants of health - Social Deprivation Index - neighborhood vulnerability

Note

This study was presented as a poster (abstract ID: 1098693) at the Society of Maternal Fetal Medicine's 42nd Annual Pregnancy Meeting.


Supplementary Material



Publication History

Received: 09 October 2022

Accepted: 19 May 2023

Article published online:
26 June 2023

© 2023. Thieme. All rights reserved.

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