Associations of area-level deprivation with adverse obstetric and perinatal outcomes in Bavaria, Germany: Results from a cross-sectional study

Abstract

Background We investigated associations of area-level deprivation with obstetric and perinatal outcomes in a large population-based routine dataset. Methods We used the data of n = 827,105 deliveries who were born in hospitals between 2009 to 2016 in Bavaria, Germany. The Bavarian Index of Multiple Deprivation (BIMD) on district level was assigned to each mother by the zip code of her residential address. We calculated odds ratios (ORs) with 95% confidence intervals (CIs) for preterm deliveries, Caesarian sections (CS), stillbirths, small for gestational age (SGA) births and low 5-minute Apgar scores by BIMD quintiles with and without adjustment for potential confounders. Results We observed a significantly increased risk for preterm deliveries in mothers from the most deprived compared to the least deprived districts (e.g. OR [95% CI] for highest compared to lowest deprivation quintile: 1.06 [1.03, 1.09]) in adjusted analyses. Increased deprivation was also associated with higher SGA and secondary CS rates, but with lower proportions of stillbirths, primary CS and low Apgar scores. When one large clinic with an unusually high stillbirth rate was excluded, the association of BIMD with stillbirths was attenuated and almost disappeared. Conclusions We found that area-level deprivation in Bavaria was positively associated with preterm and SGA births, confirming previous studies. In contrast, the finding of an inverse association between deprivation and both stillbirth rates and low Apgar score came somewhat

Assessing the relationship between adverse pregnancy outcomes and area-level deprivation in Wales 2014–2019: a national population-based cross-sectional study

“…Much of the literature from the UK [13][14][15] has found a significant association between area-level deprivation and pregnancy outcomes as did a recent study from Germany which also looked at the relationship between area-level deprivation and multiple pregnancy outcomes. 19 Most of the UK research has focused on England and not distinguished between urban and rural areas. Compared with both Scotland and England, more of the Welsh population live in rural areas 29 which may explain the lack of a clear relationship between area-level deprivation and adverse pregnancy outcomes as was predicted a priori.…”

“…There is a body of evidence showing a relationship between adverse pregnancy outcomes and area-level deprivation. [14][15][16][17][18][19] Much of this literature has focused on a single pregnancy outcome. However, a study from Germany 19 investigated multiple birth outcomes including caesarean section, SGA, preterm birth, stillbirth and low 5-minute after birth Apgar score.…”

“…[14][15][16][17][18][19] Much of this literature has focused on a single pregnancy outcome. However, a study from Germany 19 investigated multiple birth outcomes including caesarean section, SGA, preterm birth, stillbirth and low 5-minute after birth Apgar score. They found a positive association between deprivation and preterm birth and SGA.…”

Health promotion networks in two districts in Bavaria, Germany: an exploratory case study mapping networks with respect to thematic agenda and location

“…We used the Bavarian Index of Multiple Deprivation (BIMD) as a measure of deprivation at the district level. The BIMD is a measure of relative deprivation which combines indicators in certain domains of deprivation to generate a comprehensive deprivation index ( 19 , 20 ). The index, last updated in 2015, consists of the following seven domains: income (weight: 25%), employment (25%), education (15%), district revenue (15%), social capital (10%), environment (5%), and security (5%) ( 19 , 21 ).…”