Social Determinants of Health, Perceived Stress Scores, and Adverse Pregnancy Outcomes

Abstract Objective This study aimed to evaluate self-reported first-trimester perceived stress and social needs and their associations with subsequent pregnancy adverse outcomes in a cohort in Hawaiʻi. Study Design In this single-center prospective cohort study, patients with singleton pregnancies were recruited from 2021 to 2022 at the time of routine first trimester genetic screening. Participants completed surveys assessing social needs and perceived stress. Pregnancy adverse outcomes, including preterm birth, hypertensive disease of pregnancy, small for gestational age, large for gestational age, and gestational diabetes, were obtained through chart review. Associations between reported social needs, perceived stress, and adverse outcomes were evaluated using multivariable logistic regressions, adjusting for demographic factors. Results Out of 351 participants, 141 (40.2%) experienced at least one adverse pregnancy outcome. For the composite adverse outcome, participants who reported food insecurity had lower odds of the composite outcome than those who did not (odds ratio = 0.47, 95% confidence interval = 0.23–0.92). No associations were observed between social needs and individual adverse outcomes. High perceived stress scores were also not associated with composite or individual adverse outcomes. Conclusion In this socially and medically high-risk Pacific-Island cohort, self-reported first trimester social needs and perceived stress scores overall were not associated with subsequent adverse pregnancy outcomes, with the exception of decreased adverse outcomes in those reporting food insecurity. These findings add to the limited data on the complex interactions between social needs, psychological stress, and pregnancy outcomes, and suggest that alternative pathways for evaluation are needed. The manifestations of perceived stress in this culturally unique population appear to differ from other Western cohorts. Key Points Food insecurity is associated with decreased adverse outcome. Perceived stress score is not associated with adverse outcomes. Interactions among social needs, stress, and outcomes are complex.