Investigation of the impact of social, behavioral, and pre-existing clinical risk factors on preeclampsia.

BACKGROUND

Preeclampsia is one of the leading causes of maternal morbidity and mortality, disproportionately impacting women from diverse backgrounds. Early identification of risk factors is critical for timely preventive interventions. This study examined the impact of socioeconomic factors, prior substance use, and pre-existing health conditions on the development of preeclampsia using the data from the NIH All of Us Research Program.

METHODS

Participants aged 18 to 55 with at least one pregnancy in the NIH All of Us research program between 2018 and 2023 were included. Relative factors considered include socioeconomic status (education, income, health insurance), substance use disorders (alcohol, cannabis, cocaine, nicotine, opioid, stimulant), and pre-existing health conditions (blood clotting, depression, diabetes, hypertension, liver failure, renal failure, thyroid-stimulating hormone). Electronic health records and surveys were used to identify the study cohort and risk factors. We conducted multivariate analysis using a generalized linear model, along with subgroup analysis.

RESULTS

A total of 12,098 individuals were identified with 14,354 pregnancy episodes after applying the inclusion and exclusion criteria, and 8.7% of the participants developed preeclampsia. They were predominantly Hispanic (43.5%), Non-Hispanic White (33.9%), and Non-Hispanic Black (14.5%), with an average age of 30.4 years (SD = 6.2). Among these individuals, 35% had a college or advanced degree, 38% reported income less than $50k, and 7% lacked health insurance. The commonly used substance use disorders were nicotine (8.5%), cannabis (3.7%), and opioids (2.2%). The leading pre-existing clinical conditions included depression (17%), followed by hypertension (8%), and diabetes (5%). Adjusted odds ratio from multivariate generalized linear model indicated that participants who had income less than $50k (OR:1.35, 95% CI: 1.05-1.74) are more likely to develop preeclampsia compared with those who had income higher than $100k. Other significant factors included stimulant use disorder (OR:2.04, 95% CI: 1.32-3.14), diabetes (OR:1.36, 95% CI: 1.07-1.70), and hypertension (OR:2.54, 95% CI: 2.12-3.05).

CONCLUSIONS

Low income, stimulant use disorder, diabetes, and hypertension were strongly associated with preeclampsia.