Abstract
Background and objective Oligohydramnios at term is associated with increased obstetric interventions and adverse perinatal outcomes. Socioeconomic status (SES) may influence these outcomes through disparities in healthcare access, health literacy, and antenatal care utilization. This study aimed to evaluate the association between SES and perinatal outcomes in women with term pregnancies complicated by isolated oligohydramnios. Methods This prospective observational study was conducted at Lumbini Provincial Hospital, Nepal, between April and October 2020. A total of 160 women with term oligohydramnios (amniotic fluid index [AFI] ≤5 cm, measured by a single radiologist using the four-quadrant technique) were enrolled. SES was classified using the Modified Kuppuswamy Scale. Because only one participant belonged to the Upper Middle class, 159 women in the Lower Middle and Upper Lower classes were included in comparative analyses. The primary outcome was a composite adverse neonatal outcome, defined as admission to the neonatal ICU (NICU), meconium aspiration, acute respiratory distress syndrome (ARDS), perinatal death, or Apgar score ≤7 at one minute. The secondary outcome was the mode of delivery. Statistical analyses included unadjusted comparisons and multivariable modeling using Firth's penalized logistic regression for neonatal outcomes and logistic plus modified Poisson regression for cesarean delivery, adjusting for maternal age, parity, and comorbidity. Results Among 159 women analyzed, the mean maternal age was 25.6 ± 4.1 years, and 112 (70.4%) were primiparous. Socioeconomic distribution was as follows: 87 (54.7%) Lower Middle and 72 (45.3%) Upper Lower. Cesarean delivery occurred in 55 (34.6%) women, with no significant association with SES after adjustment (adjusted risk ratio [aRR] 0.97; 95% CI: 0.63-1.48). Composite adverse neonatal outcomes occurred in 9 (5.7%) cases, and SES was not significantly associated (adjusted odds ratio 0.79; 95% confidence interval [CI]: 0.19-3.35). Maternal comorbidity was independently associated with increased risk of adverse neonatal outcomes (adjusted odds ratio [aOR]: 10.87; 95% CI: 1.56-75.62). Conclusions In this cohort of 159 term pregnancies with oligohydramnios, no significant association was detected between SES and either neonatal outcomes or mode of delivery, with analyses restricted to the Lower Middle and Upper Lower classes. Maternal comorbidity, however, emerged as a significant predictor of adverse neonatal outcomes. These findings suggest that within a tertiary hospital setting, standardized monitoring and neonatal care may reduce the impact of socioeconomic disparities, while emphasizing the importance of optimizing maternal health to improve perinatal outcomes.