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Research cohort details connections between societal factors and health after pregnancy

David M. Haas, MS, MD

Dr. David Haas

So often research is about making discoveries and probing new information. But from time to time, it confirms troubling suspicions medical professionals already have.

Such was the case in a recent study involving clinician-scientists in the Indiana University School of Medicine Department of Obstetrics and Gynecology that linked negative social determinants of health during a first pregnancy to an increased risk of developing a cardiometabolic disease in the years after giving birth.

IU School of Medicine is one of eight academic medical centers across the country involved in nuMoM2b, or the Nulliparous Pregnancy Outcomes Study: Monitoring Mothers-to-Be. This research cohort began in 2010 and monitored pregnant people delivering a child for the first time. The research team followed these original study participants three to seven years later, examining the impact of pregnancy complications on cardiovascular health. The team continues to follow the cohort today.

Social determinants of health, or SDOH, are social factors that influence a person’s overall wellness and well-being, including, for example, economic stability, education, and access to food, health care and community support.

In this particular nuMoM2b study on heart health, the cohort followed 4,484 patients for just over three years after giving birth.

Researchers found that 13.6% of participants developed metabolic syndrome, which can include such symptoms as high blood pressure, high blood sugar, excess fat and poor cholesterol levels, all of which increase a person’s risk of heart attack and stroke.

Further, researchers determined that rates of metabolic syndrome were higher in those of a lower socioeconomic status as well as those who lacked college education, had low health literacy or were single when they became a parent.

The findings were published in the American Heart Journal earlier this year.

It has become more widely recognized in recent years that people’s environment and their living and social situations have as much of an impact on their health as other medical factors traditionally studied in research, said David M. Haas, MD, MS, the Robert A. Munsick Professor of Obstetrics and Gynecology, who leads the nuMoM2b work done at IU School of Medicine.

However, little data existed affirming how social determinants of health at the time of first pregnancy impact someone’s future cardiometabolic health, mainly developing diabetes and cardiovascular disease.

Trying to understand these relationships is crucial, Haas said, because it leads to understanding what of these social risk factors are modifiable in order to improve long-term health. That’s what led the nuMoM2b study team to pursue this work.

The study’s findings weren’t surprising, and even build upon work being done by other investigators at IU into social determinants of health and their impacts in multiple areas of population health, Haas said.

The takeaway for providers—of pregnant and nonpregnant individuals—should be the importance of understanding all health factors in their communities. Doctors should be asking patients about social determinants of health and how they might be impacting health behaviors, Haas said. These factors can influence a patient’s ability to come in for office visits, take prescribed medications, or follow other behavioral health advice given to them.

And it’s essential to prepare future doctors for tackling these sometimes-difficult conversations.

“We need to start early, in medical school, to get providers comfortable with these sensitive topics,” Haas said. “As a society, we need to also destigmatize these conversations and work towards a common goal of population health. If we can hold that as the core goal to health care, discussing all relevant factors with patients should become less difficult.”

The views expressed in this content represent the perspective and opinions of the author and may or may not represent the position of Indiana University School of Medicine.
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Caitlin VanOverberghe

Caitlin VanOverberghe is a communications coordinator for the Indiana University School of Medicine, where she supports the Department of Orthopaedic Surgery and the Department of Ophthalmology. Having earned degrees in journalism and telecommunications ...