Human Development Index (HDI) of the maternal country of origin as a predictor of perinatal outcomes - a longitudinal study conducted in Spain

Abstract

BackgroundIn an era of worldwide population displacement, recent studies have identified strong associations between social situations and perinatal outcomes among immigrants. Little is known about the effect of maternal social background on pregnancy outcomes. The Human Development Index (HDI) assesses the following dimensions of human development: life expectancy, education level and income. The objective of our study was to determine if maternal HDI may be used to identify women at increased odds of poor pregnancy outcomes.MethodsWe conducted a longitudinal population-based study in a tertiary centre in Madrid, Spain. The outcome variables were maternal and perinatal/antenatal mortality, preeclampsia (PE), low birth weight (LBW), gestational diabetes mellitus (GDM), preterm delivery (PTD) before 37 and 34 gestational weeks, abnormal cardiotocography (CTG) during delivery, C-section (CS) due to abnormal CTG, pH < 7.10 at birth, Apgar at 5 min ≤ 7, and resuscitation type ≥3. We performed multivariate logistic regression analyses adjusted for potential confounding variables to evaluate the associations between maternal HDI and perinatal outcomes.ResultsIn total, 38,719 singleton infants who were born in our maternity ward between 2010 and 2016 and had perinatal outcome data available were included in this study. The neonates of women from medium/low HDI countries had significantly lower odds of low birth weight (LBW) than their very high HDI country counterparts (OR 0.63, 95% CI 0.55–0.72). However, the odds of PTD before 37 gestational weeks and PE were higher in the medium/low HDI group than the very high HDI group (OR 1.26, 95% CI 1.04–1.53; OR 1.35, 95% CI 1.02–1.79, respectively). Poorer neonatal outcomes were identified in the medium/low HDI group than the very high HDI group, including greater odds of abnormal CTG, CS due to abnormal CTG and Apgar 2 ≤ 7 (p < 0.05).ConclusionsOur findings suggest that the infants of mothers from medium/low HDI had lower odds of LBW but higher odds of PTD, PE and poor neonatal outcomes. These results support the hypothesis that maternal HDI can be used to understand the impact of maternal origin on pregnancy outcomes. Further studies are needed to confirm its validity.

Maternal Mortality Among Immigrant Women in Europe and the USA: a Systematic Review

“…Garcia-Tizon Larroca et al [11] used the HDI (Human Development Index) to classify the origin of the patients. This index is an indicator of the degree of human development in the country of origin prepared by the United Nations Development Program.…”

“…This index is an indicator of the degree of human development in the country of origin prepared by the United Nations Development Program. This parameter evaluates the arithmetic mean of three fundamental dimensions in the life of the citizens: the life expectancy at birth, the adult literacy rate and the per capita income in international dollars [11].…”

Maternal mortality in Spain and its association with country of origin: cross-sectional study during the period 1999–2015

“…Risk profiles among immigrant women differ according to the political, social and economic characteristics of the country of origin. Some authors have proposed using sociological indexes such as the HDI (Human Development Index) to define the risks of adverse perinatal events for each pregnant woman depending on the country of origin [ 7 , 8 ]. Many research studies in obstetrics have focused on immigrant women.…”

Diarrhea deaths in children among countries with different levels of the human development index

“…In addition, HDI values were obtained from UNDP website [7] . Human development index is combined of three parts, including life expectancy at birth, mean years of schooling, and gross national income per capita and its value is between 0 and 1 [8] , [9] , [10] , [11] .…”