747 - Pregnant Women & Their Babies: Unhealthy Trends (2013-2021)

Poster Number: 747
Publication Number: 747.246

Paul D. Winchester, IUSM, Bargersville, IN, United States; Jun Ying, University of Arkansas for Medical Sciences, Little Rock, AR, United States; Matthew D. Durbin, Indiana University School of Medicine, Indianapolis, IN, United States; Catherine Proctor, Indiana University School of Medicine, Indianapolis, IN, United States; Angie Crook, Riley Hospital for Children at Indiana University Health, Martinsville, IN, United States; Julie A. Barton, IUHP, Greenfield, IN, United States; Harjot Kaur, Indiana University School of Medicine, Indianapolis, IN, United States; Manas S. Yadav, Hamilton Southeastern High School, Fishers, IN, United States; Mahrina E. Miller, Indiana University School of Medicine, Carmel, IN, United States

Background: Maternal pregnancy-related mortality and morbidity rates have risen in the US. This decline in maternal health could be accompanied by a decline in neonatal health.

Objective: To assess maternal morbidity in pregnancy and adverse neonatal outcomes from 2013-2021.

Design/Methods: CDC natality data 2013-2021 was analyzed for maternal and neonatal morbidities in live singleton births 22-41 weeks. Maternal: diabetes (DM) (type 1/2/gest), hypertensive disorders (HDP), obesity (pre-pregnancy BMI ≥30), late/no prenatal care (IPNC), Medicaid, c-section, advanced maternal age >34 yrs (AMA), infertility treatment (ITRT). Neonatal: preterm birth (PTB) (< 37 weeks), % LGA or SGA, 5'APGAR < 7, Assisted Ventilation Immediate (AVI) or >6hours (AV6), NICU admission, neonatal mortality (time of natality report).  The same maternal and neonatal variables were assessed in a subcohort of lower-risk social determinants: ≥HS education, private insurance, age 20-34 yrs. Statistical analysis: Multivariate logistical regression models assessed odds ratios (OR's) of binary maternal risk factors and neonatal outcomes using 2013 as the reference, after adjusting for demographics and other covariates.

Results: 31,350,222 singleton live births 22-41 weeks were included in analysis. Maternal obesity (24.79%-31.05%), DM (6.25%-9.58%), HTN (6.37%-11.87%), ITRT (1.07%-1.94%), AMA (16.06%-20.44%), IPNC (5.75%-5.99%) increased respectively (p's< 0.001). Medicaid (41.51%-39.46%), c-section (31.88%-31.2%) declined (p's< 0.001). Neonatal adverse outcomes: PTB (7.66%-8.66%), NICU (6.84%-8.51%), AVI (2.96%-5.18%), AV6 (0.86%-1.68%), APGARS< 7 (1.73%-1.96%) increased significantly (p's< 0.001). Lower-risk women and their offspring showed lower rates of obesity and DM but higher rates of HTN and ITRT but other maternal variables (except Medicaid and c-section) rose over the study period.  AVI and AV6, NICU, PTB, also rose significantly in lower-risk maternal subgroup p's< 0.001. Overall LGA and SGA rates were mixed, and short-term mortality rates decreased, p's< 0.001.

Conclusion(s): Rates of maternal morbidities in pregnancy rose significantly even in lower-risk women. Similarly adverse neonatal outcomes rose from 2013-2021.  Increasing obesity and perinatal maternal mortality have been replicated across multiple generations in animal models of pregnancies exposed to environmentally relevant levels of pesticides and other chemicals. Most American women now carry a body burden of these "obesogens". Whether environmental chemicals are causing the deteriorating maternal and neonatal health indicators in humans would require additional research.