COMMUNITY CASE STUDY article
Front. Med.
Sec. Obstetrics and Gynecology
Characterizing Intersecting Social Determinants of Health During Pregnancy: A Descriptive Cross-Sectional Analysis from a Northern New England Health System
Provisionally accepted
- 1The Dartmouth Institute for Health Policy and Clinical Practice, Dartmouth College, Lebanon, United States
- 2Department of Obstetrics and Gynecology, Dartmouth Health, Lebanon, NH, United States
- 3Department of Population Health, Dartmouth Health, Lebanon, NH, United States
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Objective: We aimed to characterize the prevalence and co-occurrence of social determinants of health among pregnant individuals during prenatal care in a single rural-based health system in the United States. Context and case: This community case study describes the implementation and findings of universal screening for social determinants of health among all individuals initiating prenatal care at four OB-GYN clinics in a single health system between January 2022 and December 2023. Antenatal sites spanned both small urban and rural settings, with a subset of deliveries occurring at a rural, tertiary care medical center. Social determinants, including financial stress, food insecurity, housing instability, transportation issues, social isolation, and health literacy, were assessed using a screening tool embedded in the electronic health record (EHR). We used descriptive statistics and UpSet Plots to describe these determinants and their co-occurrence patterns in relation to patient characteristics. Findings: Among 2,222 pregnant individuals who completed screening, 16.7% reported at least one social determinant, and 7.8% reported two or more. Among patients who screened positive for only one determinant, the most common concern was social isolation (38.9%), followed by financial stress (27.8%). Among those with two or more determinants, the most common items were financial stress (75.1%), food insecurity (67.6%), and housing instability (56.1%). Combinations of food insecurity, housing instability, and financial stress affected nearly one in ten patients. Conclusions: Social isolation emerged as a significant concern for non-urban pregnant women who had no other reported social determinants. However, determinants also co-occurred, particularly housing and food insecurity with financial stress. This descriptive analysis provides foundational data for future research examining associations between intersecting social determinants and maternal-infant health outcomes. Universal screening is critically important for identifying patients with high social risk.
Keywords: social determinants of health, Prenatal Care, screening, rural, health equity
Received: 03 Jul 2025; Accepted: 25 Nov 2025.
Copyright: © 2025 Dev, Allen, Cass, Canavan, Velmineti and Goodman. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Alka Dev
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