Abstract Body (Do not enter title and authors here):
Background: Employment instability and related socioeconomic stressors are increasingly recognized as critical social determinants of health (SDOH) affecting maternal cardiovascular outcomes. This study evaluates the impact of employment-related SDOH on cardiovascular and maternal outcomes during the fourth trimester.

Methods: A retrospective cohort analysis was conducted using the TriNetX U.S. Collaborative Network, comprising 64 healthcare organizations. Female patients aged 15–60 years with documented labor, delivery, or postpartum encounters between 2008 and 2023 were included. Two cohorts were defined: those with employment-related SDOH codes (n = 5,229 after matching) and those without any SDOH codes (n = 5,229 after matching). Propensity score matching was applied to balance demographic and clinical characteristics. Outcomes were assessed over a 12-month postpartum period and included all-cause mortality, acute myocardial infarction (AMI), stroke, heart failure, preeclampsia/eclampsia, and major adverse cardiovascular and cerebrovascular events (MACCE).

Results: The employment-related SDOH cohort had a significantly higher risk of all-cause mortality (Risk Ratio [RR]: 3.10; p < 0.001), 3-point MACCE (RR: 2.10; p = 0.003), and 4-point MACCE (RR: 2.06; p = 0.002). Kaplan-Meier analyses revealed lower survival probabilities in the SDOH group for several outcomes. While preeclampsia and acute MI rates were similar between cohorts, systolic heart failure incidence showed a higher hazard in the SDOH cohort (HR: 2.22; p = 0.041).

Conclusion: Employment-related SDOH are associated with increased maternal cardiovascular risk and mortality during the postpartum period. These findings underscore the urgent need for socioeconomic screening and policy-driven interventions targeting employment and financial stability during and after pregnancy.