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. 2025 Jun;5(2):12.
doi: 10.3390/women5020012. Epub 2025 Apr 2.

Association Between Severity of COVID-19 and Social Determinants of Health with Adverse Pregnancy Outcomes in a Study of Mother-Infant Pairs in Los Angeles, California

Sarah Daouk  1 , Tara Kerin  1 , Trevon Fuller  2 , Olivia Man  3 , Mary C Cambou  4 , Viviana Fajardo-Martinez  1 , Sophia Paiola  1 , Thalia Mok  5 , Rashmi Rao  5 , Karin Nielsen-Saines  1
Affiliations

Association Between Severity of COVID-19 and Social Determinants of Health with Adverse Pregnancy Outcomes in a Study of Mother-Infant Pairs in Los Angeles, California

Sarah Daouk et al. Women (Basel). 2025 Jun.

Abstract

Previous cross-sectional studies have investigated social determinants of health (SDOH) among pregnant women with COVID-19. However, there are scant data on the impact of these determinants on maternal outcomes from cohorts of pregnant women with COVID-19. We evaluated the association between social determinants of health and both COVID-19 severity and adverse pregnancy outcomes (APOs) in a cohort of pregnant women in Los Angeles (L.A.) County, California. The APOs considered were fetal loss, gestational hypertensive disorders, prolonged rupture of membranes, and maternal death. We recruited pregnant women with confirmed SARS-CoV-2 and collected data on maternal COVID-19 severity, trimester at diagnosis, comorbidities, mode of delivery, COVID-19 vaccination, APOs, maternal age, medical insurance type, race/ethnicity, and neighborhood income. Participants who were obese were more likely to experience severe COVID-19 (OR: 3.61, 95% CI: 1.44-9.46), while even one vaccine dose before COVID-19 infection was associated with reduced odds of severe disease (OR:0.14, 95% CI: 0.02-0.52). Pregnant participants living in low-income areas were more likely to experience APOs (p = 0.01) and severe COVID-19 (p = 0.009). This suggests that economic inequities could negatively impact maternal outcomes among pregnant women with COVID-19. We also found that SDOH moderated severity effects on APOs in Black women vs. non-Black women. These findings underscore the importance of considering social determinants of health to improve maternal health.

Keywords: COMP cohort; COVID-19 severity; adverse pregnancy outcomes; pregnancy; social determinants of health.

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Conflict of interest statement

Conflicts of Interest: The authors declare no conflicts of interest.

Figures

Figure 1.
Figure 1.
Los Angeles County map of mean household income per capita.
Figure 2.
Figure 2.
Association between per capita income, maternal COVID-19 severity, and adverse pregnancy outcomes at the ZIP code scale. (Average income was lower in ZIP codes where pregnant participants who experienced adverse outcomes resided. Income was also lower in the home ZIP codes of pregnant participants with severe or critical COVID-19. Each gray dot depicts the home zip code of pregnant participants. Horizontal bars indicate the average income per group).
Figure 3.
Figure 3.
Adverse pregnancy outcomes and household income in the Los Angeles area by ZIP code. Each dot represents one pregnant participant.
Figure 4.
Figure 4.
Trends over time: (A) COVID-19 cases among patients with high vs. low income in Los Angeles County. Alternating color/white areas represent the time when the coordinating strain was most prevalent. (B) Adverse pregnancy Outcomes (APO) overtime, and (C) Implementation of vaccines and COVID-19 treatment options available to the cohort.
Figure 5.
Figure 5.
SDOG moderates the effect of COVID-19 severity on APO.
See this image and copyright information in PMC

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