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
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Little is known about how community characteristics influence PAS outcomes.
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In a referral center, transfusion was more common in gravidae living in socially deprived
areas.
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Future research should consider how community characteristics can impact PAS outcomes.
Keywords
placenta accreta spectrum - social determinants of health - Social Deprivation Index
- neighborhood vulnerability
