Association between maternal social deprivation and prenatal care utilization: the PreCARE cohort study

Abstract

BackgroundMaternal social deprivation is associated with an increased risk of adverse maternal and perinatal outcomes. Inadequate prenatal care utilization (PCU) is likely to be an important intermediate factor. The health care system in France provides essential health services to all pregnant women irrespective of their socioeconomic status. Our aim was to assess the association between maternal social deprivation and PCU.MethodsThe analysis was performed in the database of the multicenter prospective PreCARE cohort study. The population source consisted in all parturient women registered for delivery in 4 university hospital maternity units, Paris, France, from October 2010 to November 2011 (N = 10,419). This analysis selected women with singleton pregnancies that ended after 22 weeks of gestation (N = 9770). The associations between maternal deprivation (four variables first considered separately and then combined as a social deprivation index: social isolation, poor or insecure housing conditions, no work-related household income, and absence of standard health insurance) and inadequate PCU were tested through multivariate logistic regressions also adjusted for immigration characteristics and education level.ResultsAttendance at prenatal care was poor for 23.3% of the study population. Crude relative risks and confidence intervals for inadequate PCU were 1.6 [1.5–1.8], 2.3 [2.1–2.6], and 3.1 [2.8–3.4], for women with a deprivation index of 1, 2, and 3, respectively, compared to women with deprivation index of 0. Each of the four deprivation variables was significantly associated with an increased risk of inadequate PCU. Because of the interaction observed between inadequate PCU and mother’s country of birth, we stratified for the latter before the multivariate analysis. After adjustment for the potential confounders, this social gradient remained for women born in France and North Africa. The prevalence of inadequate PCU among women born in sub-Saharan Africa was 34.7%; the social gradient in this group was attenuated and no longer significant. Other factors independently associated with inadequate PCU were maternal age, recent immigration, and unplanned or unwanted pregnancy.ConclusionSocial deprivation is independently associated with an increased risk of inadequate PCU. Recognition of risk factors is an important step in identifying barriers to PCU and developing measures to overcome them.Electronic supplementary materialThe online version of this article (doi:10.1186/s12884-017-1310-z) contains supplementary material, which is available to authorized users.

Associations between maternal obesity and severe maternal morbidity: Findings from the French EPIMOMS population‐based study

“…These findings are consistent with prior investigations linking SMM risk with maternal origin, race, or ethnicity: sub‐Saharan African migrant women have previously been found to have a higher risk of maternal mortality and SMM in European countries, and in the United States, black and Latina women have disproportionately higher rates of SMM as compared to white women . Previous studies suggest that access and quality of care issues may be implicated in SMM among individuals with known social risk factors …”

“…A Of note, the UK, 18 Australian, 17 [28][29][30] Previous studies suggest that access and quality of care issues may be implicated in SMM among individuals with known social risk factors. 31,32…”

Maternal obesity and severe pre-eclampsia among immigrant women: a mediation analysis

“…Sample. The PreCARE multicenter cohort study was designed to evaluate the association between social deprivation and perinatal outcomes and to investigate the mechanisms of social health inequalities 27 . All women registered to deliver or who delivered at one of the four participating university hospitals in Paris between October 2010-November 2011 were eligible for study inclusion (n = 10,419).…”

Social Vulnerability in Congenital Syphilis Case Mothers: Qualitative Assessment of Cases in Indiana, 2014 to 2016

“…We developed a codebook using both a priori and emergent codes, and applied these codes across all 23 cases to capture concepts and themes. Previous large-scale studies in the UK and France 7, 8 used indices formed from individual or group factors for the purpose of classifying maternal vulnerability, referred to as the Social Deprivation Index and Index of Multiple Deprivation, respectively. Factors considered in these studies include: social isolation; poor or insecure housing; no work-related household income; inadequate or no health insurance; level of health in area of residence; employment; education; crime in area of residence.…”

“…Social vulnerability and deprivation in mothers often is associated with an increased risk of inadequate prenatal care, 7,8 and “socioeconomic factors interfere more with prenatal care and are most responsible by the lack of adequate treatment…for maternal syphilis.” 9 Lack of timely and adequate prenatal care is related to numerous structural, psychosocial and behavioral factors, including lack of or late enrollment in insurance or Medicaid, cost of co-pays, lack of transportation or child care, unawareness of the pregnancy, unwanted or unplanned pregnancy, and mental health and substance abuse issues. 10–19 In recent decades, increased attention has been paid in public health to the interactions among structural barriers, social conditions, and disease; and the way that these interactions often concentrate or combine to negatively affect both individual and population health.…”