Am J Perinatol
DOI: 10.1055/a-2185-8882
Original Article

The Childhood Opportunity Index's Association with Adverse Pregnancy and Newborn Outcomes in Nulliparous Persons

Olivia C. Abraham
1   Department of Obstetrics and Gynecology, Indiana University School of Medicine, Indianapolis, Indiana
Alekhya Jampa
1   Department of Obstetrics and Gynecology, Indiana University School of Medicine, Indianapolis, Indiana
Sara K. Quinney
1   Department of Obstetrics and Gynecology, Indiana University School of Medicine, Indianapolis, Indiana
1   Department of Obstetrics and Gynecology, Indiana University School of Medicine, Indianapolis, Indiana
› Author Affiliations
Funding Support for the original nuMoM2b study at Indiana University was provided by the National Institutes of Health (approval no.: U10HD06037 [Haas]). The additional work to derive the Index scores and current analysis provided with internal department funding.


Objective The objective of the study was to determine if using a novel measure of social determinants of health, the Childhood Opportunity Index (COI), at the time of delivery was associated with development of adverse pregnancy outcomes (APO) in nulliparous pregnant persons.

Study Design Data were extracted from the 779 participants from a single nuMoM2b (Nulliparous Pregnancy Outcomes Study: monitoring mothers-to-be) study site, a prospective cohort study designed to identify contributors to APOs. Residential address information at delivery was linked to the location's COI. The overall composite and component scores in education, health and environmental, and socioeconomic indices were recorded. APOs of interest included preterm birth, hypertensive disorders of pregnancy, small for gestational age at birth, stillbirth, and gestational diabetes. Participant characteristics were compared by COI category and the association of COI with APOs was analyzed by logistic regression, controlling for age and self-reported race/ethnicity.

Results The overall COI distribution was very low (45%), low (17%), moderate (10%), high (15%), and very high (13%). A total of 329 (43.5%) participants experienced at least one APO. Overall COI was associated with developing an APO (p = 0.02). Each component score was also associated with developing APOs and with race/ethnicity (p < 0.05). Compared with higher COI categories, an overall low or very low categorized location was independently associated with developing an APO (odds ratio: 1.636, 95% confidence interval: 1.16–2.31). Adjusting for gestational age at birth, those in lower COI areas had newborns with lower birth weight, birth length, and head circumference (estimate [95% confidence interval] birth weight: −0.0005 g [−0.0008 to −0.0001]; length: −0.065 cm [−0.124 to −0.0091]; head circumference: −0.123 cm [−0.208 to −0.045]). COI was not associated with other newborn outcomes.

Conclusion COI, a marker for social determinants of health, is independently associated with APOs. The COI may be a tool for risk stratification for pregnant people to help with APO-reducing strategies.

Key Points

  • The COI is a neighborhood-level marker for social determinants of health.

  • The COI at time of delivery is associated with APO and newborn birth weight, length, and head circumference.

  • The COI may be usable in pregnancy clinics to help identify resource needs to optimize outcomes for pregnant individuals and newborns.


Part this work was presented as an abstract to the 2023 Annual Meeting of the Society for Academic Specialists in Obstetrics and Gynecology in Baltimore, MD. Other parts of this work have been submitted as an abstract for the 2023 American College of Obstetricians and Gynecologists District V Annual Meeting for October 2023.

Supplementary Material

Publication History

Received: 14 August 2023

Accepted: 27 September 2023

Accepted Manuscript online:
04 October 2023

Article published online:
01 November 2023

© 2023. Thieme. All rights reserved.

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