# Association Between Severity of COVID-19 and Social Determinants of Health with Adverse Pregnancy Outcomes in a Study of Mother–Infant Pairs in Los Angeles, California

## TL;DR

This study shows that social and economic factors worsen outcomes for pregnant women with severe COVID-19 in Los Angeles.

## Contribution

The study links social determinants of health to both severe COVID-19 and adverse pregnancy outcomes in a specific geographic cohort.

## Key findings

- Obese pregnant women were more likely to experience severe COVID-19.
- Pregnant women in low-income areas had higher rates of adverse pregnancy outcomes and severe disease.
- SDOH effects on outcomes were more pronounced in Black women compared to non-Black women.

## Abstract

Previous cross-sectional studies have investigated social determinants of health (SDOH) among pregnant women with COVID-19. However, there are scant data on the impact of these determinants on maternal outcomes from cohorts of pregnant women with COVID-19. We evaluated the association between social determinants of health and both COVID-19 severity and adverse pregnancy outcomes (APOs) in a cohort of pregnant women in Los Angeles (L.A.) County, California. The APOs considered were fetal loss, gestational hypertensive disorders, prolonged rupture of membranes, and maternal death. We recruited pregnant women with confirmed SARS-CoV-2 and collected data on maternal COVID-19 severity, trimester at diagnosis, comorbidities, mode of delivery, COVID-19 vaccination, APOs, maternal age, medical insurance type, race/ethnicity, and neighborhood income. Participants who were obese were more likely to experience severe COVID-19 (OR: 3.61, 95% CI: 1.44–9.46), while even one vaccine dose before COVID-19 infection was associated with reduced odds of severe disease (OR:0.14, 95% CI: 0.02–0.52). Pregnant participants living in low-income areas were more likely to experience APOs (p = 0.01) and severe COVID-19 (p = 0.009). This suggests that economic inequities could negatively impact maternal outcomes among pregnant women with COVID-19. We also found that SDOH moderated severity effects on APOs in Black women vs. non-Black women. These findings underscore the importance of considering social determinants of health to improve maternal health.