Abstract Body (Do not enter title and authors here):
Background: Social determinants of health (SDOH), particularly adverse physical, housing, and environmental conditions, are increasingly recognized as key drivers of maternal and cardiovascular health disparities during the fourth trimester. This study investigates the impact of SDOH on postpartum cardiovascular and related outcomes in a large, real-world U.S. population.

Methods: A retrospective comparative outcomes analysis was performed using the TriNetX U.S. Collaborative Network, comprising electronic medical records from 64 healthcare organizations. Two cohorts of females aged 15–60 years at delivery and postpartum were compared between 2008 and 2023: one with documented SDOH related to the social environment (n = 18,411 after matching) and one without SDOH (n = 18,411 after matching). Propensity score matching was used to balance baseline characteristics. Outcomes were assessed over a one-year period following delivery and included mortality, acute myocardial infarction (AMI), stroke, heart failure, peripartum cardiomyopathy, preeclampsia/eclampsia, venous thromboembolism (VTE), and major adverse cardiovascular and cerebrovascular events (MACCE).

Results: Patients exposed to SDOH had significantly higher risks of all-cause mortality (Risk Ratio [RR]: 3.43, p < 0.001), AMI (RR: 2.10, p = 0.048), and 3-point MACCE (RR: 2.85, p < 0.001). Risk for peripartum preeclampsia was also elevated (RR: 1.22, p < 0.001). Survival analysis confirmed significantly lower survival probabilities in the SDOH group for several outcomes. The matched cohort analysis showed these disparities persisted even after adjusting for key demographic and clinical confounders.

Conclusion: Exposure to adverse SDOH conditions during the peripartum period is associated with a significantly higher risk of maternal cardiovascular and mortality outcomes. These findings underscore the importance of addressing structural and environmental inequities to improve maternal health and reduce postpartum cardiovascular risk.