The Relationship between Social Determinants of Health and Pregnancy Outcomes: A Retrospective Cohort Study in Tabriz

Abstract

Ab s t r a c tPurpose: To assess the effects of social determinants of health on pregnancy outcome in rural and urban areas of Tabriz.Methods: A retrospective cohort study design was used to examine 600 pregnant women who attended antenatal health care services in Tabriz, Iran from August 2012 to the October 2013. They were followed up from the sixth week of gestation to three months after delivery. Socioeconomic indicators and some other measures such as body mass index, family income status, maternal education and occupation, cigarette smoking, depression, intimate partner violence based upon health ministry guidelines and pregnancy outcomes including low birth weight, small for gestational, and preterm delivery, cesarean delivery and miscarriage were assessed . Results:The mean age of women was 26.1 ± 6.6 years in rural and 27.9 ± 5.7 years in urban areas and the mean duration of pregnancy was 39.03± 1.36 weeks. There was a significant association between maternal education, cesarean section and abortion. BMI played a major role on almost all poor pregnancy outcomes (LBW, PTB, cesarean section, miscarriage) and income status was the first predictor of low birth weight. Socio demographic and behavioral factors were particularly important for predicting miscarriage, preterm labor and low birth weight. Conclusion:Although residential area (rural versus urban of Tabriz) was associated with preterm labor, low birth weight and cesarean section , only cesarean section had a significant effect after adjusting for confounding factors such as income and education level, age, parity, obstetrical complications .Disparity in distribution of resources in rural and urban area were the main factors that made the pregnancy complicated in our study.

The Relationship Between the Social Determinants of Health and Preterm Birth in Iran Based on the WHO Model: A Systematic Review and Meta-analysis

“…Generation of Results As shown in Figure 2, evaluating the relationship between education and preterm birth, Alizadeh et al showed that preterm birth is more common in illiterate compared to educated women. The odds of preterm birth were 4.31 times higher in illiterate compared to educated women (2.64%-7.03%: 95% CI) (36); but in the studies by Neshat et al (33), Mirzaei et al (30), and Sehati Shafaei et al (29), this was not statistically significant (P > 0.05). In 5 studies that examined the relationship between job and preterm birth, there was no statistically significant relationship between woman ' s job and preterm birth (29,30,36,37,39).…”

“…The odds of preterm birth were 4.31 times higher in illiterate compared to educated women (2.64%-7.03%: 95% CI) (36); but in the studies by Neshat et al (33), Mirzaei et al (30), and Sehati Shafaei et al (29), this was not statistically significant (P > 0.05). In 5 studies that examined the relationship between job and preterm birth, there was no statistically significant relationship between woman ' s job and preterm birth (29,30,36,37,39). Moreover, in the review of the relationship between the place of residence and preterm birth, the difference was not statistically significant between the prevalence of preterm birth in women living in rural areas compared to urban residents (29,39).…”

“…Of the 16 papers reviewed, 9 were cross-sectional (24-32), 4 were cohort (33)(34)(35)(36), and 3 were case-control (37-39).…”

“…Six of the studies had also examined the relationship between the structural determinants of health and preterm birth, and 4 of these 6 had examined preterm birth in relation to education (29,30,33,36), 5 in relation to occupation (29,30,36,37,39), and 2 in relation to the place of residence (29,39), as shown in Table 2.…”

“…All 16 studies had examined the relationship between the intermediate determinants of health and preterm birth, but of all the determinants based on the WHO model, only 7 were examined, including anxiety in 3 studies (33)(34)(35), depression in 2 (33,36), violence in 7 (24,(26)(27)(28)32,36), unwanted pregnancy in 2 (29,36), poor health behaviors in 2 (37,38), exposure to secondhand tobacco smoke in 3 (31,36,40), and prenatal care in 2 studies (36,39) (Table 3). Generation of Results As shown in Figure 2, evaluating the relationship between education and preterm birth, Alizadeh et al showed that preterm birth is more common in illiterate compared to educated women.…”