Rebecca Smith

Date of Award

January 2025

Document Type

Dissertation

Degree Name

Doctor of Philosophy (PhD)

Department

Nursing

First Advisor

Dawn Denny

Abstract

Severe maternal morbidity (SMM) remains a significant public health concern in the United States, with rates rising despite advancements in obstetric care. While extensive research has examined the role of clinical risk factors in SMM, less attention has been given to the influence of social determinants of health (SDOH). Factors such as financial insecurity, food access, housing stability, intimate partner violence, social connectedness, and transportation barriers may contribute to maternal health disparities. This study aims to assess the relationship between SDOH and SMM, evaluating how these non-clinical factors shape maternal health outcomes. Additionally, this research explores the impact of maternal risk factors—including tobacco use, alcohol use, stress, physical activity, and depression—and rurality on SMM outcomes.This study utilizes a retrospective quantitative approach, analyzing a dataset of over 33,000 deliveries. Missing data were handled using listwise deletion, resulting in a dataset of 6,840 cases. Descriptive statistics and chi-square analyses were conducted to identify significant differences between SMM and non-SMM cases across SDOH. Logistic regression models were employed to assess the predictive strength of SDOH and maternal risk factors on maternal morbidity. The analysis was conducted in three models: (1) assessing the role of SDOH, (2) including maternal risk factors, and (3) including rurality to examine geographic disparities. The results indicate that financial insecurity and intimate partner violence are significantly associated with SMM outcomes. These findings support the critical need for healthcare providers and healthcare systems to integrate social and behavioral risk screening into prenatal care to improve maternal health outcomes. Addressing the intersection of SDOH and maternal health through early interventions and targeted support may be essential in reducing maternal morbidity and achieving health equity.

Download

Share

COinS