Identifying Urban Built Environment Factors in Pregnancy Care and Maternal Mental Health Outcomes

Backgrounds: Environmental risk factors related to the built environment have been associated with women’s mental health and preventive care. This study sought to identify built environment factors that are associated with variations in prenatal care and subsequent pregnancy-related outcomes in an urban setting. Methods: In a retrospective observational study using machine learning, we characterized the types and frequency of events in prenatal care that are associated with the various built environment factors of the patients’ residing neighborhoods. We hypothesize that, in comparison to women living in high-quality built environments, women who reside in low-quality built environments experience a different pattern of clinical events that may increase the risk for adverse outcomes. Using machine learning, we performed pattern detection to characterize the variability in prenatal care with respect to encounter types, clinical problems, and medication prescriptions. Structural equation modeling was used to test the associations among built environment, prenatal care variation, and pregnancy outcome. The main outcome is postpartum depression (PPD) diagnosis within 1 year following childbirth. The exposures were the quality of the built environment in the patients’ residing neighborhoods. Electronic health records (EHR) data of pregnant women (n=8,949) who had live delivery at an urban academic medical center in 2015 to 2017 were included in the study. Results: We discovered prenatal care patterns that were summarized into three common types. Women who experienced the prenatal care pattern with the highest rates of PPD were more likely to reside in neighborhoods with homogeneous land use, lower walkability, lower air pollutant concentration, and lower accessibility to retail stores after adjusting for age, neighborhood average education level, marital status, and income inequality. Conclusions: In an urban setting, multi-purpose and walkable communities were found to be associated with a lower risk of PPD. Findings may inform urban design policies and provide awareness for care providers on the association of patients’ residing neighborhoods and healthy pregnancy.