The Association Between Rural‐Urban Continuum, Maternal Education and Adverse Birth Outcomes in Québec, Canada

Auger, Nathalie; Authier, Marie; Martinez, Jérôme; Daniel, Mark

doi:10.1111/j.1748-0361.2009.00242.x

Cited by 40 publications

(31 citation statements)

References 41 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…13 Most studies examining geographic barriers to maternity care in industrialized countries focused solely on perinatal death and infant mortality and morbidity, showing elevated rates among infants of women residing in rural areas. 14,[16][17][18][19][20] Geographic disparity in severe maternal morbidity has not been adequately examined.…”

Section: Resultsmentioning

confidence: 99%

“…Most studies of rural maternity care have focused solely on infant outcomes, [16][17][18][19][20]29,30 and population-based studies examining different components of severe maternal morbidity associated with rural residence in industrialized countries are rare. Our study showed that the risk of Note: CI = confidence interval, CNS = central nervous system, OR = odds ratio.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Maternal morbidity and perinatal outcomes among women in rural versus urban areas

Lisonkova

Haslam

Dahlgren

et al. 2016

CMAJ

View full text Add to dashboard Cite

show abstract

Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Maternal morbidity and perinatal outcomes among women in rural versus urban areas

Lisonkova

Haslam

Dahlgren

et al. 2016

CMAJ

View full text Add to dashboard Cite

show abstract

“…2e) could be due to the transmission of negative behaviours due to such behaviours being more common [50], and where less support for cessation may lead to smoking throughout pregnancy [51]. The dichotomized definition used to represent rural residential addresses may obscure mechanisms which can be modified by maternal factors such as education [52]. …”

Section: Discussionmentioning

confidence: 99%

Air pollution, neighbourhood and maternal-level factors modify the effect of smoking on birth weight: a multilevel analysis in British Columbia, Canada

et al. 2016

View full text Add to dashboard Cite

BackgroundMaternal smoking during pregnancy negatively impacts fetal growth, but the effect is not homogenous across the population. We sought to determine how the relationship between cigarette use and fetal growth is modified by the social and physical environment.MethodsBirth records with covariates were obtained from the BC Perinatal Database Registry (N = 232,291). Maternal smoking status was self-reported as the number of cigarettes smoked per day usually at the first prenatal care visit. Census dissemination areas (DAs) were used as neighbourhood-level units and linked to individual births using residential postal codes to assign exposure to particulate air pollution (PM2.5) and neighbourhood-level attributes such as socioeconomic status (SES), proportion of post-secondary education, immigrant density and living in a rural place. Random coefficient models were used with cigarettes/day modeled with a random slope to estimate its between-DA variability and test cross-level interactions with the neighbourhood-level variables on continuous birth weight.ResultsA significant negative and non-linear association was found between maternal smoking and birth weight. There was significant between-DA intercept variability in birth weight as well as between-DA slope variability of maternal smoking on birth weight of which 68 and 30 % respectively was explained with the inclusion of DA-level variables and their cross-level interactions. High DA-level SES had a strong positive association with birth weight but the effect was moderated with increased cigarettes/day. Conversely, heavy smokers showed the largest increases in birth weight with rising neighbourhood education levels. Increased levels of PM2.5 and immigrant density were negatively associated with birth weight, but showed positive interactions with increased levels of smoking. Older maternal age and suspected drug or alcohol use both had negative interactions with increased levels of maternal smoking.ConclusionMaternal smoking had a negative and non-linear dose-response association with birth weight which was highly variable between neighbourhoods and evidence of effect modification with neighbourhood-level factors. These results suggest that focusing exclusively on individual behaviours may have limited success in improving outcomes without addressing the contextual influences at the neighbourhood-level. Further studies are needed to corroborate our findings and to understand how neighbourhood-level attributes interact with smoking to affect birth outcomes.

show abstract

“…In addition to other pesticide exposures, proximity to agricultural activity is associated with coexposures to a variety of fertilizers that are applied in particularly large quantities in corn-growing areas (Ochoa-Acuña and Carbajo, 2009). Further, residence in agricultural areas has been linked to adverse birth outcomes with a wide range of postulated causes, which (in addition to fertilizers and pesticides) include microbial toxins (Missmer et al, 2006; Gelineau-van Waes et al, 2009), diet and lifestyle (Giordano et al, 2008; Elliott et al, 2009), and socioeconomic problems (Auger et al, 2009), although in many studies the specific risk factors remained unknown (Batra et al, 2007; Gonzalez et al, 2008; Messer et al, 2010). …”

Section: Discussionmentioning

confidence: 99%

Atrazine and Pregnancy Outcomes: A Systematic Review of Epidemiologic Evidence

Goodman

Mandel

DeSesso

et al. 2014

Birth Defects Research Pt B

View full text Add to dashboard Cite

Atrazine (ATR) is a commonly used agricultural herbicide that has been the subject of epidemiologic studies assessing its relation to reproductive health problems. This review evaluates both the consistency and the quality of epidemiologic evidence testing the hypothesis that ATR exposure, at usually encountered levels, is a risk factor for birth defects, small for gestational age birth weight, prematurity, miscarriages, and problems of fetal growth and development. We followed the current methodological guidelines for systematic reviews by using two independent researchers to identify, retrieve, and evaluate the relevant epidemiologic literature on the relation of ATR to various adverse outcomes of birth and pregnancy. Each eligible paper was summarized with respect to its methods and results with particular attention to study design and exposure assessment, which have been cited as the main areas of weakness in ATR research. As a quantitative meta-analysis was not feasible, the study results were categorized qualitatively as positive, null, or mixed. The literature on ATR and pregnancy-related health outcomes is growing rapidly, but the quality of the data is poor with most papers using aggregate rather than individual-level information. Without good quality data, the results are difficult to assess; however, it is worth noting that none of the outcome categories demonstrated consistent positive associations across studies. Considering the poor quality of the data and the lack of robust findings across studies, conclusions about a causal link between ATR and adverse pregnancy outcomes are not warranted.

show abstract

The Association Between Rural‐Urban Continuum, Maternal Education and Adverse Birth Outcomes in Québec, Canada

Abstract: Differences in perinatal health exist across the rural-urban continuum, and maternal education has a modifying influence.

Cited by 40 publications

References 41 publications

Maternal morbidity and perinatal outcomes among women in rural versus urban areas

Maternal morbidity and perinatal outcomes among women in rural versus urban areas

Air pollution, neighbourhood and maternal-level factors modify the effect of smoking on birth weight: a multilevel analysis in British Columbia, Canada

Atrazine and Pregnancy Outcomes: A Systematic Review of Epidemiologic Evidence

Contact Info

Product

Resources

About