Social Determinants of Health

Defined as the “conditions in the environments in which people are born, live, learn, work, play, worship, and age,” the social determinants of health are important predictors of health outcomes. While medical care is estimated to account for up to 20% of modifiable health outcomes, the other 80% is attributed to social factors, such as availability of safe housing, access to educational and economic opportunities, social support, and residential segregation.

Severe Maternal Morbidity

Severe Maternal Morbidity

Severe maternal morbidity (SMM) includes unintended outcomes of labor and delivery resulting in significant short-term and long-term consequences to a woman’s health. In the US, SMM is 100 times more common than maternal mortality and has been increasing over time. Disparities also persist with Black and low-income women most likely to be affected. Our work aims to characterize the individual, social, and structural factors that contribute to SMM risk. Currently, we are studying associations between SMM and co-morbid conditions (hypertension and diabetes) and using multi-level approaches to understand how social determinants of health, including neighborhood-level characteristics, influence SMM risk.

Key Finding

Hypertensive Disorders of Pregnancy, Cesarean Delivery, and Severe Maternal Morbidity in an Urban Safety Net Population

We found that women with hypertensive disorders of pregnancy had an over twofold increased risk for SMM, compared with women without hypertensive disorders of pregnancy.

Hypertensive Disorders of Pregnancy

Hypertensive Disorders of Pregnancy

Hypertensive disorders of pregnancy (HDP), including chronic hypertension, gestational hypertension, preeclampsia-eclampsia, and preeclampsia superimposed on chronic hypertension, affect 6-10% of all pregnancies in the US and are a leading cause of maternal and perinatal morbidity and mortality. Our research focuses on patterns of health care utilization and outcomes for women with HDP. In collaboration with the Department of Biomedical Informatics, we are testing the feasibility a mobile health home blood pressure telemonitoring system for postpartum women who were diagnosed with a hypertensive disorder during their pregnancy.

Key Finding

Demographic and Clinical Predictors of Postpartum Blood Pressure Screening Attendance 

Among 1,360 women diagnosed with hypertensive disorder of pregnancy, only 24% attended a recommended blood pressure screening visit in the early postpartum period.

COVID-19

COVID-19

Early data from the COVID-19 pandemic suggest that pregnant women are at increased risk for severe illness than nonpregnant women. Moreover, there are alarming disparities in rates of infection, with racial and ethnic minorities and socioeconomically disadvantaged groups bearing a disproportionate burden of illness, hospitalization, and death. In addition to assessing disparities in infection rates among pregnant women, we are conducting a mixed methods study to evaluate impact of the transition to telehealth on prenatal care access and quality, and maternal health outcomes during the pandemic.

Key Finding

Sociodemographic and neighborhood predictors of SARS-CoV-2 infection in obstetric patients in two urban Atlanta hospitals.

In cohort study of 1,882 pregnant women in Atlanta, GA, we found that the prevalence of SARS-CoV-2 infection was highest among women who were Hispanic, uninsured, or lived in high-density neighborhoods.

Maternal Vaccination

Maternal Vaccination

Despite longstanding recommendations, rates of influenza and tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis (Tdap) vaccination during pregnancy remain suboptimal, with clear disparities in rates of uptake.  Our work involves efforts to better understand factors that contribute to low rates of maternal vaccine acceptance and the development of new approaches to overcome barriers to vaccination.

Key Finding

Trends in Infant Pertussis Hospitalizations in the United States, 2009-2017

We found a decline in pertussis hospitalization rates among young infants following 2012 recommendations for the administration of tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis (Tdap) vaccine during every pregnancy. Our findings suggest that maternal Tdap vaccination is associated with lower rates of death and hospitalization and reduced disease severity among young infants with pertussis.

Additional Findings:

  1. “Predictors of tetanus, diphtheria, acellular pertussis and influenza vaccination during pregnancy among full-term deliveries in a medically underserved population”
  2. “Factors Associated with Antenatal Influenza Vaccination in a Medically Underserved Population”