Neighborhood Deprivation and Hypertensive Disorders of Pregnancy: Does Social Support Modify the Association?

BACKGROUND

Previous studies have reported associations between neighborhood deprivation and hypertensive disorders of pregnancy (HDP), but without considering effect measure modification by social support.

METHODS

This study used the Nulliparous Pregnancy Outcomes Study: Monitoring Mothers-To-Be longitudinal cohort, which recruited participants between 2010 and 2013 across the United States. We used linear probability models with robust standard errors to estimate risk differences for associations of the area deprivation index (ADI) and social support with HDP. Perceived social support was categorized as low/moderate versus high, and effect measure modification was assessed by comparing stratum-specific risk differences; analyses were stratified by race/ethnicity.

RESULTS

The analytic sample included n = 7,349 participants. A 25-percentile increase in ADI was associated with two excess cases of gestational hypertension per 100 pregnancies among non-Hispanic Black participants (risk difference = 0.02, 95% confidence interval = -0.01, 0.05), while estimates among Hispanic and Asian participants suggested reduced risk. Participants reporting high social support had three fewer cases of preeclampsia/eclampsia per 100 pregnancies (risk difference = -0.03, 95% confidence interval = -0.05, 0.00) compared with those reporting low or moderate social support, though this lower risk was observed only among non-Hispanic White and Asian participants. There was no evidence that high social support modified the association between neighborhood deprivation and HDP.

CONCLUSION

Neighborhood deprivation was associated with increased incidence of HDP among non-Hispanic Black people, and social support was associated with lower incidence of preeclampsia/eclampsia among non-Hispanic White and Asian people. However, we did not find evidence of social support buffering the association between neighborhood deprivation and HDP.