Session: Neo-Perinatal Health Care Delivery: Epidemiology/Health Services Research 2
85 - Social Drivers of Health, Antenatal Morbidities, and Early Death in Infants Born Extremely Preterm
Sunday, April 26, 2026
9:30am - 11:30am ET
Publication Number: 3081.85
Jane E. Brumbaugh, Mayo Clinic, Rochester, MN, United States; Dhuly Chowdhury, RTI International, Rockville, MD, United States; Waldemar Carlo, University of Alabama, Birmingham, AL, United States; Matthew Rysavy, McGovern Medical School at the University of Texas Health Science Center at Houston, Houston, TX, United States; Edward F. Bell, University of Iowa, Iowa City, IA, United States; Ravi M. Patel, Children's Healthcare of Atlanta and Emory University, Atlanta, GA, United States; Colm P. Travers, University of Alabama at Birmingham, Birmingham, AL, United States; Vivek V. Shukla, University of Alabama at Birmingham, Birmingham, AL, United States; Andrea F.. Duncan, Children's Hospital of Philadelphia and University of Pennsylvania, Philadelphia, PA, United States; Samantha Chang, RTI International, Austin, TX, United States; Tarah Colaizy, University of Iowa Stead Family Children's Hospital, Iowa City, IA, United States; on behalf of NICHD Neonatal Research Network, NICHD Neonatal Research Network, Bethesda, MD, United States
Associate Professor Mayo Clinic Rochester, Minnesota, United States
Background: Both social drivers of health (SDoH) and antenatal morbidities are associated with outcomes of infants born extremely preterm. Characterizing SDoH and antenatal morbidities of infants affected by early death (≤12 hours) within the context of stillbirths, later in-hospital deaths, and survival to discharge may lead to interventions that reduce infant mortality. Objective: To characterize SDoH of infants born extremely preterm affected by early death and to evaluate whether antenatal morbidities mediate the relationship between SDoH and early death. Design/Methods: This is a secondary analysis of a cohort of stillbirths and inborn preterm infants (220/7–286/7 weeks’ gestation) born 9/2017–12/2024 within NICHD Neonatal Research Network centers. Infants with unknown maternal insurance status were excluded. For the mediation analysis, any SDoH was the exposure, antenatal morbidities were mediators, and infant survival was the outcome. Risk-associated SDoH included public/no insurance, unmarried status, Black race, and Hispanic ethnicity. Antenatal morbidities included maternal hypertension, chorioamnionitis, prolonged rupture of membranes (PROM), and insulin-dependent diabetes. Infant survival was categorized as stillbirth after maternal admission, early death, later death (>12 hours), or survival to discharge or 120 days. The mediation analysis was adjusted for delivery mode, multiple births, small for gestational age, and antenatal steroids. Results: The cohort included 13,860 infants: 608 stillbirths, 969 early deaths, 1936 later deaths, and 10,347 survivors (Figure). Black race was highest among stillbirths while Hispanic ethnicity was highest among early deaths. Public/no insurance and unmarried status did not vary by infant outcome (Table 1). Of the antenatal morbidities, maternal hypertension and diabetes were highest among stillbirths. Chorioamnionitis and PROM were highest among infants who experienced early death. SDoH were associated with 29% higher adjusted odds of early death compared to survival without evidence of mediation by antenatal morbidities (Table 2). Among infants who died early, postnatal life support (vs. comfort care) was more common among those with mothers who had public/no insurance (62% vs. 49%, p< 0.001), identified as Black (39% vs. 30%, p=0.009), or were unmarried (56% vs. 49%, p=0.039).
Conclusion(s): SDoH were associated with early death, and the association was not mediated by antenatal morbidities. These findings may inform perinatal counseling and public health actions aimed at reducing early neonatal mortality through maternal welfare and care access.
