(101) Does Neighborhood Disadvantage Affect Pregnant Patients With Opioid Use Disorder?

Background & Introduction: Social determinants of health (SDOH) are the conditions in which a person is born, grows, and lives that shape their overall health. SDOH have fueled the opioid crisis and contribute to opioid use disorder (OUD). They also have a profound impact on obstetric outcomes, including but not limited to preterm birth and maternal mortality. The level of resources and/or social support in the neighborhood where one resides may influence these outcomes. The Area Deprivation Index (ADI) is a mapping tool that displays the relative socioeconomic conditions of neighborhoods based on publicly available data on income, education, employment, housing quality, etc. [1] The ADI identifies neighborhoods with the highest levels of disadvantage. Currently, there is a paucity of information on the association between neighborhood disadvantage and OUD in pregnancy. [2] The purpose of this study was to determine the ADI’s relationship with pregnancy characteristics and perinatal outcomes in patients on medications for OUD (MOUD).

Methods: This was a retrospective cohort study of pregnant patients on MOUD who delivered at a single institution between 2017 and 2023. The ADI was determined using the University of Wisconsin’s Neighborhood Atlas [3] based on the patient’s mailing address at time of delivery admission. ADI was characterized as a state decile ranging from 1 to 10, with 10 representing the highest deprivation areas. Patients were excluded if they provided a P.O. box number for their address or if an ADI was not available for their address. Charts were abstracted for pregnancy characteristics and perinatal/neonatal outcomes. Statistical analyses were performed using Mann-Whitney U and Chi-square tests with a p-value < 0.05 deemed statistically significant.

Results: 404 patients were included in the analysis. When comparing those with higher (ADI 7 or greater) and lower (ADI less than 7) neighborhood deprivation, a statistically significant difference was noted in the percent of multiparous patients (50.6% vs. 36.2%, p=0.01), the percent of patients who initiated MOUD in pregnancy (42.6% vs. 26.5%, p=0.02), the percent of patients diagnosed with gestational diabetes (12.5% vs. 4.9%, p=0.01) and the percent of patients undergoing Cesarean delivery (37.1% vs. 52.7%, p=0.009). Additionally, a difference was noted in the median gravidity (4 vs. 3, p=0.01), median parity (2 vs. 1, p=0.02), and median length of neonatal hospital stay (9 vs. 8, p=0.02). There was no difference in additional demographic factors, comorbidities, obstetric outcomes, and neonatal outcomes between the two groups.

Conclusion & Discussion: Pregnant MOUD patients residing in more highly disadvantaged neighborhoods were more likely to be multiparous, have initiated MOUD in pregnancy, have higher gravidity and higher parity, develop gestational diabetes, and require a longer length of hospital stay for their newborn. They were less likely to undergo Cesarean delivery. Limitations of this study include its retrospective design, the unavailability of an ADI for all patients, and potential confounding variables.

References: 1. Kind AJH, Buckingham WR. Making Neighborhood-Disadvantage Metrics Accessible - The Neighborhood Atlas. N Engl J Med. 2018;378(26):2456-2458. doi:10.1056/NEJMp1802313.
2. Pahl A, Hu Z, Young LW, et al. Maternal Area of Residence and Outcomes for Mother-Infant Dyads with Perinatal Opioid Exposure. Am J Perinatol. Published online June 16, 2025. doi:10.1055/a-2622-3839
3. University of Wisconsin School of Medicine Public Health. 2015 Area Deprivation Index v2.0. Downloaded from https://www.neighborhoodatlas.medicine.wisc.edu