Abstract
OBJECTIVE: The social adaptability index (SAI) is a composite indicator capturing an individual's social adaptability within society and socioeconomic status to predict overall health outcomes. The objective of this analysis was to examine whether the SAI is an independent risk factor for adverse pregnancy outcomes in women with and without diabetes during pregnancy. METHODS: Data from the 2011-2017 National Survey of Family Growth were analyzed using a cross-sectional methodology. Women aged 18-44 years with a singleton gestation were included in the analysis. Maternal diabetes was defined as either presence of pregestational diabetes or diagnosis of gestational diabetes. The SAI was developed from the following maternal variables: educational level, employment status, income, marital status, and substance abuse. A higher score indicated lower risk. A series of multivariable logistic regression models were run stratified by maternal diabetes status to assess the association between SAI and pregnancy outcomes, including cesarean delivery, macrosomia (birth weight ≥4,000 g) and preterm birth (<37 weeks). All analyses were weighted and P <0.05 was considered significant. RESULTS: A total of 17,772 women were included in the analysis, with 1,965 (10.7%) having maternal diabetes during pregnancy. The SAI was lower in women with diabetes during pregnancy compared with control subjects (6.7 ± 0.2 vs. 7.2 ± 0.1, P <0.001). After adjusting for maternal race and ethnicity, insurance status, BMI, age, and partner support of the index pregnancy, SAI was associated with preterm birth among women with diabetes during pregnancy (adjusted odds ratio 0.83, 95% CI 0.72-0.94). The SAI was not significantly associated with cesarean delivery or macrosomia in women with diabetes during pregnancy and was not associated with these outcomes in women without diabetes during pregnancy. CONCLUSION: Among women with diabetes during pregnancy, a higher SAI is independently associated with a lower risk of preterm birth. The SAI could be a useful index to identify women at high risk of preterm birth in addition to traditionally defined demographic risk groups among women with diabetes during pregnancy.