Abstract Body (Do not enter title and authors here):
Background:
Social determinants of health (SDOH), particularly those related to upbringing (ICD-10: Z62), are increasingly recognized as potential contributors to adverse maternal cardiovascular outcomes. This study aims to evaluate the impact of upbringing-related SDOH on maternal and cardiovascular health in the fourth trimester (up to 1 year postpartum).

Methods:
Using the TriNetX US Collaborative Network, a retrospective cohort study analyzed females aged 15–60 with delivery or postpartum encounters between 2008 and 2023. Cohort 1 included 5,639 patients with upbringing-related SDOH, while Cohort 2 included 1,876,884 without any SDOH exposure. After 1:1 propensity score matching, 5,450 patients were included in each cohort. Outcomes were assessed within 365 days of the index event.

Results:
Patients with upbringing-related SDOH had significantly higher risks of all-cause mortality (1.1% vs. 0.2%; OR 6.14, p<0.001), cardiac arrest (0.2% vs. 0%; p=0.002), and 3-/4-point MACCE (1.2% vs. 0.2%; p<0.001). No significant differences were observed for acute myocardial infarction, ischemic or hemorrhagic stroke, peripartum preeclampsia or eclampsia, or most heart failure subtypes. End-stage heart failure risk was notably elevated in the SDOH cohort (0.2% vs. 0%; p=0.002). Survival analysis showed lower survival probabilities at 1 year for those with SDOH exposure across several endpoints.

Conclusions:
Upbringing-related SDOH are independently associated with higher odds of mortality, major adverse cardiac events, and cardiac arrest during the postpartum year. These findings emphasize the importance of incorporating SDOH screening and interventions into peripartum care models to mitigate cardiovascular risk.