Socioeconomic gradients of adverse birth outcomes and related maternal factors in rural and urban Alberta, Canada: a concentration index approach

Ospina, Maria; Osornio-Vargas, Álvaro; Nielsen, Charlene C.; Crawford, Susan; Kumar, Manoj; Aziz, Khalid; Serrano-Lomelin, Jesús

doi:10.1136/bmjopen-2019-033296

Cited by 18 publications

(25 citation statements)

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“…Models were determined a priori and were adjusted for the following variables based on existing evidence: maternal age at delivery 23 (<20, 20-24, 25-29, 30-34, 35-39, ≥40); marital status at birth registration 24 (married, partner, single); area deprivation based on levels of index of multiple deprivation score 25 26 (for babies born in 2005 and 2006, index of multiple deprivation scores from 2004 and 2007 were used, respectively); child’s ethnicity based on the 2001 census classification (white British, white other, Bangladeshi, Indian, Pakistani, black African, black Caribbean, other); mother’s country of birth 27 (UK or non-UK born); mode of delivery 28 (vaginal, caesarean section); parity 9 24 (nulliparous, parous); month of birth 29 (January-March, April-June, July-September, October-December), sex 26 (male, female), and small for gestational age 9 (yes, no).…”

Section: Methodsmentioning

confidence: 99%

Gestational age and hospital admissions during childhood: population based, record linkage study in England (TIGAR study)

Coathup

Boyle

Carson

et al. 2020

BMJ

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ObjectiveTo examine the association between gestational age at birth and hospital admissions to age 10 years and how admission rates change throughout childhood.DesignPopulation based, record linkage, cohort study in England.SettingNHS hospitals in England, United Kingdom.Participants1 018 136 live, singleton births in NHS hospitals in England between January 2005 and December 2006.Main outcome measuresPrimary outcome was all inpatient hospital admissions from birth to age 10, death, or study end (March 2015); secondary outcome was the main cause of admission, which was defined as the World Health Organization’s first international classification of diseases, version 10 (ICD-10) code within each hospital admission record.Results1 315 338 admissions occurred between 1 January 2005 and 31 March 2015, and 831 729 (63%) were emergency admissions. 525 039 (52%) of 1 018 136 children were admitted to hospital at least once during the study period. Hospital admissions during childhood were strongly associated with gestational age at birth (<28, 28-29, 30-31, 32, 33, 34, 35, 36, 37, 38, 39, 40, 41, and 42 weeks). In comparison with children born at full term (40 weeks’ gestation), those born extremely preterm (<28 weeks) had the highest rate of hospital admission throughout childhood (adjusted rate ratio 4.92, 95% confidence interval 4.58 to 5.30). Even children born at 38 weeks had a higher rate of hospital admission throughout childhood (1.19, 1.16 to 1.22). The association between gestational age and hospital admission decreased with increasing age (interaction P<0.001). Children born earlier than 28 weeks had an adjusted rate ratio of 6.34 (95% confidence interval 5.80 to 6.85) at age less than 1 year, declining to 3.28 (2.82 to 3.82) at ages 7-10, in comparison with those born full term; whereas in children born at 38 weeks, the adjusted rate ratios were 1.29 (1.27 to 1.31) and 1.16 (1.13 to 1.19), during infancy and ages 7-10, respectively. Infection was the main cause of excess hospital admissions at all ages, but particularly during infancy. Respiratory and gastrointestinal conditions also accounted for a large proportion of admissions during the first two years of life.ConclusionsThe association between gestational age and hospital admission rates decreased with age, but an excess risk remained throughout childhood, even among children born at 38 and 39 weeks of gestation. Strategies aimed at the prevention and management of childhood infections should target children born preterm and those born a few weeks early.

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Section: Methodsmentioning

confidence: 99%

Gestational age and hospital admissions during childhood: population based, record linkage study in England (TIGAR study)

Coathup

Boyle

Carson

et al. 2020

BMJ

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“… 30 In other countries, for example, Canada and France, heterogeneity in the impact of deprivation by rurality on adverse pregnancy outcomes has been found. 31 32 The French study 32 found differences in risks of SGA comparing women living in deprived areas in rural and urban Brittany. Deprivation experienced by women living in rural areas may differ from that of women in urban areas.…”

Section: Discussionmentioning

confidence: 99%

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

et al. 2021

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ObjectivesThe aim of this study was to assess the relationship between deciles of area-level deprivation and seven adverse pregnancy outcomes in Wales.DesignCross-sectional analysis.Setting64 699 live births in Wales from 31 March 2014 to 16 September 2019.Primary outcome variableWe examined each of the following seven adverse pregnancy outcomes: (1) small for gestational age (SGA); (2) large for gestational age; (3) preterm birth; (4) third-degree or fourth-degree perineal tear; (5) major postpartum haemorrhage (MPPH); (6) a lower Apgar score at 5 min and (7) emergency caesarean section.ResultsThere was no significant association between increasing aggregate measures of area-level deprivation and the adverse pregnancy outcomes we studied. Women living in an area with greater access to services are more likely to have a baby that is SGA (1.27, 95% CI 1.11 to 1.49), have a greater likelihood of a perineal tear (1.74, 95% CI 1.15 to 2.61), are significantly less likely to have MPPH (0.79, 95% CI 0.64 to 0.96), have a baby with an Apgar score of 0.26 higher (95% CI 0.22 to 0.29) and are significantly less likely to have an emergency caesarean section (0.81, 95% CI 0.73 to 0.88). Women living in areas with higher employment (0.26, 95% CI 0.19 to 0.36) and better health (0.26, 95% CI 0.19 to 0.35) were less likely to experience perineal tear.ConclusionsThere was no clear social-spatial gradient in area-level deprivation and adverse pregnancy outcomes. We found a stronger association for individual-level behavioural risk factors than area-level factors. These findings support the benefits that accessible and holistic person-centred care may bring through addressing individual behavioural risk factors. There is a need for improved data completeness and further individual-level data on risk factors such as employment and income to better understand the role which may be played by population-level policies and their pathways to affecting outcomes.

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“…We found that primiparous women with severe mental disorders had low SES. Previous studies have shown that smoking is more frequent among women, who are unmarried and/or have low educational attainment ( 14 , 18 ). One study including nulliparous women focused on their health literacy.…”

Section: Discussionmentioning

confidence: 99%

“…In pregnant women, mental disorders are associated with socioeconomic status (SES) ( 12 , 14 , 17 , 18 ). In most studies, SES is associated with maternal age, smoking, educational attainment, income, and cohabiting ( 12 , 14 ). Smoking is more frequent among women, who are unmarried and/or have low educational attainment ( 14 , 18 ).…”

Section: Introductionmentioning

confidence: 99%

Preconception Mental Health, Socioeconomic Status, and Pregnancy Outcomes in Primiparous Women

Björkstedt

Koponen

Kautiainen

et al. 2022

Front. Public Health

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Background:One in four women of childbearing age has some degree of mental disorders and are, therefore, prone to both pregnancy complications and adverse health outcomes in their offspring. We aimed to evaluate the impact of preconception severe mental disorders on pregnancy outcomes in primiparous women.MethodsThe study cohort was composed of 6,189 Finnish primiparous women without previously diagnosed diabetes, who delivered between 2009 and 2015, living in the city of Vantaa, Finland. Women were classified to have a preconception severe mental disorder if they had one or more outpatient visits to a psychiatrist or hospitalization with a psychiatric diagnosis 1 year before conception. Data on pregnancies, diagnoses, and pregnancy outcomes were obtained from national registers at an individual level.ResultsPrimiparous women with preconception severe psychiatric diagnosis were younger, more often living alone, smokers, and had lower educational attainment and lower taxable income than women without psychiatric diagnosis (for all p < 0.001). Of all women, 3.4% had at least one psychiatric diagnosis. The most common psychiatric diagnoses were depression and anxiety disorders. The most common comorbidity was the combination of depression and anxiety disorders. There were no differences in the need for respiratory treatments, admissions to the neonatal intensive care unit, or antibiotic treatments between the offspring's groups.ConclusionAlthough primiparous women had severe mental disorders, the well-being of newborns was good. The most common severe mental health disorders were depression and anxiety disorders, and psychiatric comorbidity was common. Women with severe mental disorders more often belonged to lower socioeconomic groups.

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Socioeconomic gradients of adverse birth outcomes and related maternal factors in rural and urban Alberta, Canada: a concentration index approach

Cited by 18 publications

References 50 publications

Gestational age and hospital admissions during childhood: population based, record linkage study in England (TIGAR study)

Gestational age and hospital admissions during childhood: population based, record linkage study in England (TIGAR study)

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

Preconception Mental Health, Socioeconomic Status, and Pregnancy Outcomes in Primiparous Women

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