PP.21 The Effect of Factors of Social Exclusion on Access to Antenatal Care and the Subsequent Impact on Fetal Outcomes

Abstract

Background Delayed access to antenatal care is linked to maternal deaths and morbidity. Social deprivation also accounts for much maternal and child ill-health, with national health data showing discrepancies in the access and utilisation of care by groups of women who differ by ethnicity, age and socioeconomic status. Objectives To map the prevalence of social deprivation and delayed access to antenatal care amongst women attending a regional referral maternity service and to correlate with fetal outcomes. Methods Retrospectively analysed data collected from 59,847 singleton births at the Jessop Wing Hospital, Sheffield, UK, between 2002 and 2010, identifying maternal demographic features and neonatal outcomes. We plotted the Index of Multiple Deprivation (IMD) scores of women against the distribution of delayed access to antenatal care. Results The geographic distribution of high deprivation scores and first pregnancy care attendance after 20 weeks gestation matched closely. High IMD scores increased the risk of being a late booker (OR: 1.092, 95% CI: 1.01–1.18, p = 0.031) and being of minority ethnic extraction (OR: 5.6, 95% CI: 5.2–5.9, p < 0.001), and significantly predicted low birth weight (OR: 1.66, 95% CI: 1.31–2.12, p < 0.001), premature delivery (OR:1.34, 95% CI: 1.06–1.70, p = 0.017) and stillbirth (OR: 2.25, 95% CI: 1.68–3.01, p < 0.001). When sociodemographic variables were adjusted for, late booking did not independently predict adverse maternal or fetal outcomes. Conclusions Disparities remain for women from certain backgrounds. Geographic mapping of high deprivation scores can direct research and health delivery strategies seeking to promote better access to pregnancy care and mitigate the resulting adverse fetal outcomes.

A multisite audit to assess how women with complex social factors access and engage with maternity services

“…A large proportion of each sample were from the most deprived quintiles of London, this is unsurprising as complex social factors and deprivation are strongly associated (Marmot and Bell, 2012). It is however an important finding when considering access to appropriate maternity services due to the correlation between socioeconomic deprivation and poor neonatal outcomes (Draper et al 2015, Mercer & Anumba (2013.…”

“…On average 89% primiparous women across all samples had less than the recommended number of antenatal appointments. Although the causal relationship between late booking, inadequate engagement and poor outcomes is as yet unknown (Mercer & Anumba 2013, Kapaya et al 2015, NICE (2010) recognise that early booking for women with social complex factors is even more important than for the general population. This is partly because these women's pregnancies are more likely to be unplanned, are associated with greater risk of premature birth, low birth weight and stillbirth, and they are more likely to be experiencing poor nutritional status and health behaviours (Kapaya, 2015, Marmot 2010and Williamson 2006.…”