Objective: The social adaptability index (SAI) is a composite indicator capturing an individual’s social adaptability within society and socioeconomic status in order to predict overall health outcomes. The objective of this analysis was to examine whether the SAI is an independent risk factor for adverse pregnancy outcomes in women whose pregnancy is complicated by diabetes.

Methods: Data from the 2011-2017 National Survey of Family Growth were analyzed using cross-sectional methodology. Women with a singleton gestation age 18-44 were included. Maternal diabetes was defined as either presence of pre-gestational diabetes or diagnosis of gestational diabetes. The SAI was developed from the following maternal variables: education level, employment status, income, marital status and substance abuse. Higher score indicates lower risk. Multivariable logistic regression models were run to assess the association between SAI and pregnancy outcomes associated with diabetes, including cesarean delivery, macrosomia (birthweight >4000g) and preterm delivery (<37 weeks), stratified by maternal diabetes. All analyses were weighted.

Results: A total of 18,304 women were included in the analysis, with 1,965 (10.7%) having diabetes during pregnancy. The SAI was lower in women with diabetes during pregnancy, compared to controls (6.7±0.2 vs. 7.2±0.1, p<0.001). In the univariable analysis, the SAI had a significant association with the outcomes of preterm delivery (OR=0.94, p<0.001) and was not significantly associated with cesarean delivery or macrosomia. In adjusted multivariable analysis, controlling for maternal race/ethnicity, insurance status, body mass index, age and partner support of the index pregnancy, SAI remained to be independently associated with preterm delivery among women with diabetes during pregnancy (aOR=0.83, 95% CI 0.77-0.94).

Conclusion: Among women with diabetes during pregnancy, a higher SAI is independently associated with a lower risk of preterm delivery.


A. Palatnik: None. M.Y. Thakkar: None. R.J. Walker: None. L.E. Egede: None.

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