Association between neighbourhood deprivation, fetal growth, small-for-gestational age and preterm birth: a population-based prospective cohort study

Abstract

ObjectiveTo study the associations between neighbourhood deprivation and fetal growth, including growth in the first trimester, and adverse pregnancy outcomes.DesignProspective cohort study.SettingThe Netherlands, Rotterdam.Participants8617 live singleton births from the Generation R cohort study.ExpositionLiving in a deprived neighbourhood.Main outcome measuresFetal growth trajectories of head circumference, weight and length.Secondary outcomes measuresSmall-for-gestational age (SGA) and preterm birth (PTB).ResultsNeighbourhood deprivation was not associated with first trimester growth. However, a higher neighbourhood status score (less deprivation) was associated with increased fetal growth in the second and third trimesters (eg, estimated fetal weight; adjusted regression coefficient 0.04, 95% CI 0.02 to 0.06). Less deprivation was also associated with decreased odds of SGA (adjusted OR 0.91, 95% CI 0.86 to 0.97, p=0.01) and PTB (adjusted OR 0.89, 95% CI 0.82 to 0.96, p=0.01).ConclusionsWe found an association between neighbourhood deprivation and fetal growth in the second and third trimester pregnancy, but not with first trimester growth. Less neighbourhood deprivation is associated with lower odds of adverse pregnancy outcomes. The associations remained after adjustment for individual-level risk factors. This supports the hypothesis that living in a deprived neighbourhood acts as an independent risk factor for fetal growth and adverse pregnancy outcomes, above and beyond individual risk factors.

Association Between Social Vulnerability and Achieving Glycemic Control Among Pregnant Individuals With Pregestational Diabetes

“…2,17 Increasing evidence supports an association between standardized measures of community-level social vulnerability and adverse pregnancy outcomes, with regards to preterm birth, [17][18][19][20] abnormal fetal growth, and severe maternal morbidity. 21,22 Although there are multiple indices to measure communitylevel social vulnerability, 23 the Centers for Disease Control and Prevention's SVI (Social Vulnerability Index) is a publicly available, online tool that integrates 15 community characteristics to provide scores for a composite summative measure as well as for four thematic domains. 24 These themes are socioeconomic status, household composition and disability, minority status and language, and housing type and transportation.…”

Cumulative Risk Evaluation of Phthalates Under TSCA

“…Low birth-weight is another reported effect of phthalates and has also been linked to maternal stress − and resource deprivation − that has likewise been seen in different cohorts and different countries. Such resource deprivation indices have not yet been widely used in the U.S. but might be considered as indices that could be adopted in CRAs at EPA, particularly in terms of vulnerability factors, as has been suggested by Phillips et al and Wang et al Currently, some efforts to develop such indices in the US are being considered. ,, It is notable that, while a significant evolution of this understanding that psychosocial stress is not simply equivalent to low socioeconomic status has occurred in human populations, animal models of stress have not similarly progressed and, as a result, encompass significant limitations with respect to human translational relevance.…”

A Retrospective Review of Social Deprivation Index and Maternal Outcomes with Placenta Accreta Spectrum from a Single Referral Center

“…3,4 Utilizing validated measures of neighborhood characteristics provides an opportunity to interrogate important social determinants of health at the community level. [10][11][12] Living in a disadvantaged neighborhood has been associated with numerous adverse health outcomes, including diabetes, cardiovascular disease, and earlier death, 13 in addition to adverse perinatal outcomes such as preterm delivery, [14][15][16] small-for-gestational age, 14,15 stillbirth, 14 and severe maternal morbidity. 17 Neighborhood vulnerability can influence health independent of personal characteristics, and interventions that fail to address neighborhood factors may be ineffective.…”

“…In this study, we aimed to evaluate whether a composite measure of community-level social deprivation is associated with maternal adverse outcomes among gravidae delivering at a single PAS referral center. Given increasing evidence linking community-level social vulnerability and adverse pregnancy outcomes, [14][15][16][17] and the complexity of care coordination required to diagnose, refer, and treat gravidae with PAS, we hypothesized that those living in disadvantaged neighborhoods would experience more adverse maternal outcomes.…”