348 - Intensity of Social Determinants of Health Adversity Predicts Maternal Milk Intake Patterns through the First Postnatal Month Among Very Preterm Infants in the NICU

Publication Number: 3335.348

Brigitta Gehl, Yale-New Haven Children's Hospital, Madison, CT, United States; Veronika Shabanova, Yale School of Medicine, New Haven, CT, United States; Ruthfirst E. A.. Ayande, Yale School of Medicine, New Haven, CT, United States; Tessa Kehoe, Yale School of Medicine, Wethersfield, CT, United States; Kristin Santoro, Harvard Medical School, Boston, MA, United States; Camilia R. Martin, Weill Cornell Medicine, New York, NY, United States; Sarah Newell. Taylor, Yale School of Medicine, New Haven, CT, United States

Background: Maternal milk (MOM) intake in the first postnatal month reduces morbidity and mortality among very preterm (VP) infants in the NICU. Despite this benefit and evidence-based methods to obtain MOM, disparities in intake persist and relate to racial and socioeconomic status, but the impact of the 5 domains social determinants of health (SDoH) is unknown.

Objective: To examine the frequency of adverse SDoH in VP infants at birth and how they relate to patterns of MOM intake through the first postnatal month as a marker of sustained lactation.

Design/Methods: This is a secondary study in a prospective cohort study of VP infants enrolled at two academic institutions between March 2022 and Augst 2025. Eligible infants were born < 32 weeks' gestation, with available nutrition and maternal survey data. MOM intake was categorized each week into tertiles (low: < 25% MOM milk, moderate: 25-74% MOM, and high:≥75% MOM). Self-reported surveys identified social risk within the five domains of SDoH, as defined by the World Health Organization, and categorized into none, one, or more than one adverse domain present. Adjusted generalized linear mixed modeling was used to examine effect of adverse SDoH on the ordinal outcome of MOM intake during the first 4 weeks.

Results: Among 172 infants-mother dyads who met inclusion criteria, 73 (42%) and 36 (21%) self-identified as a racial minority and Hispanic/Latino ethnicity, respectively (Table 1). Adverse SDoH were identified in 57% with 38% identifying ≥2 (Table 2). In adjusted analyses, mothers with no or one adverse SDoH had a similar pattern of MOM feeding, with a significant increase from week 1 to week 2 of those receiving a high intake of MOM (p < 0.001) and remained high through weeks 2-4 (Figure 1). Despite a similar pattern in MOM increase from week 1 to week 2 (p < 0.0001), mothers with >2 adverse SDoH showed a decrease in high MOM intake from week 2 through week 4 (p=0.001). Additionally, mother's with ≥ 2 adverse SDoH had consistently lower adjusted probability of high MOM intake as compared to the other two SDoH categories (p=0.001).

Conclusion(s): In our study population of VP infants, adversity in ≥2 SDoH domains demonstrated a pattern of decreased MOM intake specifically from week 2 to week 4, which differed from those with one or no adverse SDoH. Our results highlight the high prevalence of social risk factors of many NICU families. Determination of detailed SDoH adversity and the temporal pattern of diminished MOM intake promotes targeted interventions to reduce disparities in MOM intake.

Table 1. Demographic and Morbidity Characteristics Among Study Mother-Infant Dyads
Categorical data shown as number (percentage); continuous data shown as mean (standard deviation). Abbreviations: Neonatal Intensive Care Unit (NICU), Necrotizing Enterocolitis (NEC)

Table 2. Social Risk Factors within the Five Domains of Social Determinants of Health Among Mothers of Very Preterm Infants in the NICU
Categorical data shown as number (percentage); Abbreviations: Neonatal Intensive Care Unit (NICU), Women Infant Children (WIC) Supplemental Nutrition Program (WIC); Unemployed defined as loss of job or disability, not including working in the home.

Figure 1. Estimated Probabilities of Each Category of MOM Intake Over Time Based on Adverse SDoH Intensity