Perinatal Social Determinants of Health (SDoH)  

July 26, 2022

Social determinants of health (SDoH) are the conditions in the environments where people are born, live, learn, work, play, worship, and age that affect a wide range of health, functioning, and quality-of-life outcomes and risks.

According to Texas Health and Human Services, Over 700 women die each year in the U.S. from pregnancy-related complications up to one year after giving birth. In Texas, approximately 4 out of 5 of these deaths are preventable.

Social determinants of health (SDoH) have a major impact on people’s health, well-being, and quality of life. Examples of SDoH include:

  • Safe housing and transportation
  • Education, job opportunities, and income
  • Access to nutritious foods and physical activity opportunities
  • Non-polluted air and safe water
  • Language and literacy skills

According to a study of the Blue Cross Blue Shield Health of America Report® series, an area especially impacted by SDoH is maternal morbidity and mortality. United States stillbirth prevalence shows significant racial disparity. 

  • Women in Black communities have a 63% higher rate of severe maternal morbidity (SMM) than women in majority white communities.
  • Women in Hispanic communities have a 32% higher rate of SMM than women in majority white communities. 

These rates are higher across all age groups and nearly all indicators examined.  Addressing SDoH includes, food, housing, employment, and safety directly impact maternal health outcomes, just promoting healthy choices alone will not eliminate these health disparities. Blue Cross and Blue Shield of Texas (BCBSTX) requests our valued providers to help by screening your pregnant members for their difficulties related to SDoH. 

In addition to addressing social factors that affect maternal health, prenatal and postpartum care (PPC) are important. Pregnant members should be seen for a prenatal visit within the first trimester or within 42 days of enrollment to the plan. Women should be seen between 7 and 84 days after delivery for a postpartum visit.

BCBSTX has a Special Beginnings program designed to help members, and their babies get off to a healthy start by providing education materials, support, pregnancy risk factor identification, ongoing communication/monitoring, and access to an online resource center. Members are supported from early pregnancy through 12 weeks after delivery.  Please advise our members to call 1-888-421-7781 to directly enroll. By addressing critical drivers of poor health and high health care costs, Special Beginnings aims to reduce the cost of health care and improve health and quality of care for Medicaid members.

By using ICD-10-CM Z codes relating to maternal fetal issues, such as low birth weight, maternal deaths and fetal deaths in utero, as part of your complete claim submission, we can better identify and assist our members find the services they need to have a successful  outcome.  The data collected supports local communities to address the health-related social needs of Medicare and Medicaid members by bridging the gap between clinical and community service providers. 

Social Determinant

ICD-10 Code/Description

Difficult/Unstable housing or housing support services instability

Z59.0 Lack of housing or

Z59.1 Inadequate housing or

Z59.8 Other problems related to housing and economic circumstances

Environmentally-compromised housing (e.g. Leg)

Z77.1 Contact with and (suspected) exposure to other environmental pollution

Food insecurity

Z59.4 Lack of adequate food and safe drinking water

Transportation difficulty

Z91.89 Other specified personal risk factors, not elsewhere classified

Interpersonal Violence

Z91.41 Personal history of adult abuse

Economic difficulties

Z59.9 Problem related to housing and economic circumstances, unspecified

Lack of social support

Z60.4 Social isolation, exclusion and rejection


Reference and review the BCBSTX Preventive Care Guidelines (PCGs), Clinical Practice Guidelines (CPGs), and Texas Health Steps THSteps for Medical Providers, which includes all current vaccine schedules, ImmTrac2 and other important guidance for treating your patients.

The above material is for informational purposes only and is not intended to be a substitute for the independent medical judgment of a physician. Physicians and other health care providers are encouraged to use their own best medical judgment based upon all available information and the condition of the patient in determining the best course of treatment.