Abstract Body (Do not enter title and authors here):
Background: The fourth trimester—the postpartum year—is a critical window for maternal health, particularly among populations facing psychosocial stressors. While adverse SDOH are known contributors to disparities in maternal outcomes, the specific influence of psychosocial domains on long-term cardiovascular and multisystem risks remains underexplored.

Methods: Using data from the TriNetX US Collaborative Network (64 healthcare organizations), we conducted a retrospective cohort analysis of 66,320 postpartum women (15–60 years) with psychosocial SDOH exposures between 2008 and 2023, compared to 1,876,884 postpartum women without documented SDOH exposures. After 1:1 propensity score matching, 42,256 patients per group were included. Outcomes—such as all-cause mortality, major adverse cardiovascular and cerebrovascular events (MACCE), heart failure subtypes, thromboembolic events, and end-organ dysfunction—were assessed over a 5-year follow-up using risk and survival analyses.

Results: Women with psychosocial stressors had significantly elevated risks of all-cause mortality (Risk Ratio [RR] = 2.08, p < 0.001), acute myocardial infarction (RR = 1.69, p = 0.003), 3-point and 4-point MACCE (RR = 1.69 for both, p < 0.001), and liver failure (RR = 2.24, p = 0.002). Increased risk was also observed for acute kidney injury (RR = 1.22, p = 0.013). Conversely, postpartum preeclampsia was less common in the SDOH group (RR = 0.78, p < 0.001), a trend warranting deeper investigation. Kaplan-Meier analysis demonstrated significantly lower survival probabilities among the psychosocial SDOH cohort across multiple outcomes.

Conclusions: Psychosocial stressors are associated with heightened maternal morbidity and mortality in the postpartum period, particularly regarding cardiovascular and systemic complications. These findings emphasize the urgent need for integrated psychosocial screening and intervention strategies in postpartum care, with implications for both clinical practice and policy to address maternal health inequities.