Neighborhood deprivation and adverse perinatal outcomes in Sweden: A population‐based register study

Abstract

Introduction Neighborhood deprivation has been associated with adverse perinatal outcomes but it is unclear to what extent maternal and social risk factors explain the association and how a stressful environment per se contributes. Material and methods A population‐based register study including 218 030 deliveries in Sweden between January 2013 and July 2017 was conducted. Exposure was living in a deprived or severely deprived area defined by the National Operations Department of the Swedish Police Authority. Adverse perinatal outcomes included preterm births, small‐for‐gestational‐age births and stillbirths. A propensity score‐based method was used to control for individual baseline characteristics. Associations were investigated with logistic regression analyses and risk estimates are presented as crude (OR) and adjusted odds ratio (aOR) with 95% confidence interval (CI). Results Living in a deprived neighborhood in Sweden was associated with extremely preterm births (deprived area OR 1.50, 95% CI 1.07‐2.11, severely deprived OR 1.90, 95% CI 1.40‐2.58), small‐for‐gestational‐age birth (deprived OR 1.45, 95% CI 1.31‐1.60, severely deprived OR 1.85, 95% CI 1.69‐2.03) and stillbirth (deprived OR 1.62, 95% CI 1.17‐2.26, severely deprived OR 1.56, 95% CI 1.11‐2.19). After accounting for individual maternal and social risk factors, the risk of small for gestational age in severely deprived areas remained (aOR 1.45, 95% CI, 1.19‐1.75). Conclusions The contextual effect of living in a deprived neighborhood on the risk of extremely preterm births, small‐for‐gestational‐age births and stillbirths was to a high extent explained by individual factors of women residing in exposed areas, yet remained for small‐for‐gestational‐age births in severely deprived areas after adjustment for maternal and social risk factors.

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

“…In our study, area-level deprivation was significantly associated with perinatal outcomes, but not always in the expected direction: While the ORs of preterm deliveries, SGA births and primary CS were increased in highly deprived regions, similar to previous studies from the United States [ 9 ] and Sweden [ 11 ], decreased risks of all other outcomes (stillbirths, secondary CS and low Apgar scores) were observed in highly deprived areas.…”

“…In our study, area-level deprivation was significantly associated with perinatal outcomes, but not always in the expected direction: While the ORs of preterm deliveries, SGA births and primary CS were increased in highly deprived regions, similar to previous studies from the United States [9] and Sweden [11], decreased risks of all other outcomes (stillbirths, secondary CS and low Apgar scores) were observed in highly deprived areas. This could make sense with respect to CS rates, which are known to be higher in mothers with high SES [29], although the observation of higher primary CS rates (conducted prior to onset of Labour) and of lower secondary CS rates (conducted after the onset of Labour) in highly deprived regions was somewhat contrary to our expectations.…”

“…A large body of the literature has shown that individual socioeconomic status (SES) is associated with various health outcomes [1], and there is evidence that low maternal SES is a potential risk factor for adverse perinatal outcomes [2][3][4]. However, a number of studies indicated that also area-level deprivation is associated with adverse obstetric and perinatal outcomes [5], e. g. gestational diabetes, Caesarian section (CS), preterm delivery, stillbirths or small for gestational age births [6][7][8][9][10][11]. All these outcomes contain major risks for mother and child.…”

The Impact of Neighbourhood Deprivation on Embryonic Growth Trajectories: Rotterdam Periconception Cohort

“…In the fully adjusted models, we found significantly negative associations between neighbourhood deprivation and embryonic growth trajectories, suggesting an independent effect of neighbourhood deprivation on embryonic growth. A neighbourhood effect above and beyond the effect of individual factors, nutrition and lifestyle on pregnancy course and outcome is previously demonstrated in the literature [5,33,39]. This emphasizes the need in clinical practice to consider the total environmental and social background when performing a risk assessment for adverse pregnancy course and outcomes [40,41].…”

Paternal violent criminality and preterm birth: a Swedish national cohort study

“…Data on dispensable household income per person the calendar year before childbirth, paternal age, maternal and paternal education until the year of childbirth, were collected from the Swedish Income and Enumeration Survey, held by Statistics Sweden. We did not collect data on neighbourhood context, as previous research suggests that neighbourhood context does not directly affect criminality or preterm birth in the Swedish context [15,16].…”