(P80) SOCIAL DEPRIVATION AND RISK OF SEXUALLY TRANSMITTED INFECTIONS DURING PREGNANCY

Background:
Prenatal sexually transmitted infections (STI) are associated with adverse pregnancy outcomes. Disparities in STI rates are observed and are likely explained by social factors rather than individual behaviors.  We examined social deprivation and risks of prenatal STIs.

Methods:
We analyzed data from 41,834 singleton pregnancies from three hospitals in Houston, TX. At the first prenatal visit, participants were screened for Chlamydia trachomatis (CT; screening rate 91.9%), Neisseria gonorrhea (GC; 91.6%), syphilis (98.1%), and HIV (92.2%) following hospital standards. Our primary exposure was the social deprivation index [quartiles (Q) 1-4, where Q1 is the least deprived and Q4 is the most deprived neighborhood] based on zipcode of residence prior to pregnancy. This index uses the American Community Survey and 7 neighborhood demographics to define deprivation. A modified Poisson regression was used to calculate relative risk (RR) and 95% confidence intervals (CI). Models were adjusted for maternal age, education, and marital status.

Results:
Participants were primarily Hispanic (53.9%), foreign-born (44.0%), on Medicaid (58.4%), and married (75.5%). Compared to Q1, those living in Q2-Q4 neighborhoods had increased risk of STIs (Q2 RR 1.34, 95% CI 1.14-1.57; Q3 RR 1.52, 95% CI 1.30-1.77; Q4 RR 1.50, 95% CI 1.28-1.76). Estimates were similar for each STI. In US-born women, living in Q4 increased risk of CT (RR 1.44, 95% CI 1.14-1.81), GC (RR 3.87, 95% CI 1.89-7.94), and syphilis (RR 2.03, 95% CI 1.23-3.35). Among foreign-born individuals, those living in Q4 had an increased risk of CT (RR 1.54, 95% CI 1.07-2.22) but no other associations were observed.

Conclusion:
Social deprivation appeared to be associated with STIs, but different patterns were observed for foreign-born and US-born individuals. Improving understanding of social determinants that drive STI disparities during pregnancy is important as STIs are increasing. Future studies should consider more granular measures for neighborhood deprivation.