A Critical Review on the Complex Interplay between Social Determinants of Health and Maternal and Infant Mortality

Dagher, Rada K.; Linares, Deborah E.

doi:10.3390/children9030394

Cited by 36 publications

(42 citation statements)

References 162 publications

(208 reference statements)

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“…Neonatal death rates may vary dramatically between preterm newborns and their full-term counterparts born at 39-40 weeks gestation. The most prevalent risk factors for newborn mortality, identified by other studies, were prematurity, gestational age of fewer than 37 weeks, low birth weight, and multiple pregnancies [36,37]. Low birth weight may occur as a consequence of prenatal growth restriction or preterm delivery, both of which are related to placental malfunction and consequent adverse fetal outcomes [38].…”

Section: Discussionmentioning

confidence: 97%

The Influence of Maternal Factors on Neonatal Intensive Care Unit Admission and In-Hospital Mortality in Premature Newborns from Western Romania: A Population-Based Study

et al. 2022

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Background and Objectives: Neonatal mortality is a global public health issue, disproportionately affecting low- and middle-income nations. Although Romania is a high-income nation, according to the European Union’s most recent demographic data, it had the second-highest infant death rate in 2019. Although significant progress has been made in the last three decades in lowering newborn mortality, more initiatives to accelerate progress are required to meet the 2030 Sustainable Development Goals (SDG) objective. Therefore, we aimed to develop an observational study to determine the influence of maternal factors on in-hospital neonatal intensive care unit admission and mortality in premature infants born in western Romania. While newborn mortality has decreased globally, the pace of decline is far less than what is desired. Materials and Methods: A retrospective study comprising 328 premature patients and 422 full-term newborns, was developed at a tertiary obstetrics and gynecology clinic in western Romania, comprising the period of the last 24 months before the COVID-19 pandemic and the first 24 months of the pandemic. Results: The following variables were identified as statistically significant risk factors for neonatal intensive care unit admission: age > 35 years, OR = 1.59; twin births, OR = 1.14; low gestational age, OR = 1.66; preeclampsia, OR = 2.33; and peripartum infection, OR = 2.25. The same risk factors, with the exception of twin births, were significantly associated with in-hospital neonatal mortality. Except for a longer duration of maternal hospitalization and neonatal therapy with surfactant, steroids, and antibiotics, the COVID-19 pandemic did not cause significant differences in the evolution and outcomes of preterm newborns. Conclusions: The major maternal risk factors for NICU admission were advanced age, twin pregnancy, low gestational age, preeclampsia, and peripartum infection. Additionally, these characteristics contributed to a high likelihood of death, despite adequate access to medical care and advanced life support for the neonates. Understanding the causes of morbidity and death in neonates admitted to the neonatal intensive care unit enables better prioritization and planning of health services, resource reallocation, and care quality improvement.

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Section: Discussionmentioning

confidence: 97%

The Influence of Maternal Factors on Neonatal Intensive Care Unit Admission and In-Hospital Mortality in Premature Newborns from Western Romania: A Population-Based Study

et al. 2022

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“…Nevertheless, MMR is still one of the leading causes of death among African women. Socioeconomic status, parity, and living in rural areas influence maternal mortality (MM) [ 8 , 9 ]. Cross-national or civil wars, insurgencies, and political upheavals also significantly influence maternal and infant mortality [ 10 , 11 , 12 , 13 , 14 ].…”

Section: Introductionmentioning

confidence: 99%

Maternal Mortality in Africa: Regional Trends (2000–2017)

Onambele

Ortega-Leon

Guillen-Aguinaga

et al. 2022

IJERPH

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Background: United Nations Sustainable Development Goals state that by 2030, the global maternal mortality rate (MMR) should be lower than 70 per 100,000 live births. MMR is still one of Africa’s leading causes of death among women. The leading causes of maternal mortality in Africa are hemorrhage and eclampsia. This research aims to study regional trends in maternal mortality (MM) in Africa. Methods: We extracted data for maternal mortality rates per 100,000 births from the United Nations Children’s Fund (UNICEF) databank from 2000 to 2017, 2017 being the last date available. Joinpoint regression was used to study the trends and estimate the annual percent change (APC). Results: Maternal mortality has decreased in Africa over the study period by an average APC of −3.0% (95% CI −2.9; −3,2%). All regions showed significant downward trends, with the greatest decreases in the South. Only the North African region is close to the United Nations’ sustainable development goals for Maternal mortality. The remaining Sub-Saharan African regions are still far from achieving the goals. Conclusions: Maternal mortality has decreased in Africa, especially in the South African region. The only region close to the United Nations’ target is the North African region. The remaining Sub-Saharan African regions are still far from achieving the goals. The West African region needs more extraordinary efforts to achieve the goals of the United Nations. Policies should ensure that all pregnant women have antenatal visits and give birth in a health facility staffed by specialized personnel.

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Section: Introductionmentioning

confidence: 99%

“…Social vulnerability encompasses many social and structural determinants of health and health inequities such as household income, employment, education, health insurance, majority (English) language ability, housing, and transportation [ 33 , 34 , 35 , 36 , 37 , 38 ]. Race and ethnicity, a variable considered in the calculation of social vulnerability [ 38 , 39 ] can be considered as a proxy for exposure to racism [ 40 , 41 ], which impacts health when experienced both interpersonally and due to the upstream effects of social and political structures within society (i.e., institutional and structural racism) [ 36 , 42 , 43 ]. High social vulnerability has been linked to inequities in maternal and infant health outcomes, including delayed diagnosis of congenital heart anomalies and a resulting higher rate of infant mortality [ 44 ], increased preterm birth rates [ 45 ], higher teen birth rates [ 46 ], and COVID-19-related maternal and infant complications [ 47 ].…”

Section: Introductionmentioning

confidence: 99%

Inequities in Availability of Evidence-Based Birth Supports to Improve Perinatal Health for Socially Vulnerable Rural Residents

et al. 2022

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Rural residents in the United States (US) have disproportionately high rates of maternal and infant mortality. Rural residents who are Black, Indigenous, and People of Color (BIPOC) face multiple social risk factors and have some of the worst maternal and infant health outcomes in the U.S. The purpose of this study was to determine the rural availability of evidence-based supports and services that promote maternal and infant health. We developed and conducted a national survey of a sample of rural hospitals. We determined for each responding hospital the county-level scores on the 2018 CDC Social Vulnerability Index (SVI). The sample’s (n = 93) median SVI score [IQR] was 0.55 [0.25–0.88]; for majority-BIPOC counties (n = 29) the median SVI score was 0.93 [0.88–0.98] compared with 0.38 [0.19–0.64] for majority-White counties (n = 64). Among counties where responding hospitals were located, 86.2% located in majority-BIPOC counties ranked in the most socially vulnerable quartile of counties nationally (SVI ≥ 0.75), compared with 14.1% of majority-White counties. In analyses adjusted for geography and hospital size, certified lactation support (aOR 0.36, 95% CI 0.13–0.97), midwifery care (aOR 0.35, 95% CI 0.12–0.99), doula support (aOR 0.30, 95% CI 0.11–0.84), postpartum support groups (aOR 0.25, 95% CI 0.09–0.68), and childbirth education classes (aOR 0.08, 95% CI 0.01–0.69) were significantly less available in the most vulnerable counties compared with less vulnerable counties. Residents in the most socially vulnerable rural counties, many of whom are BIPOC and thus at higher risk for poor birth outcomes, are significantly less likely to have access to evidence-based supports for maternal and infant health.

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A Critical Review on the Complex Interplay between Social Determinants of Health and Maternal and Infant Mortality

Cited by 36 publications

References 162 publications

The Influence of Maternal Factors on Neonatal Intensive Care Unit Admission and In-Hospital Mortality in Premature Newborns from Western Romania: A Population-Based Study

The Influence of Maternal Factors on Neonatal Intensive Care Unit Admission and In-Hospital Mortality in Premature Newborns from Western Romania: A Population-Based Study

Maternal Mortality in Africa: Regional Trends (2000–2017)

Inequities in Availability of Evidence-Based Birth Supports to Improve Perinatal Health for Socially Vulnerable Rural Residents

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