Variation in severe maternal morbidity according to socioeconomic position: a UK national case-control study (original) (raw)
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Socio-economic Status and pregnancy outcome. An Australian study
BJOG: An International Journal of Obstetrics and Gynaecology, 1989
A prospective cohort of 8556 pregnant women attending the Mater Misericordiae Mothers' Hospital in Brisbane was examined to consider the impact of socioeconomic status on pregnancy outcome. The indicators of socioeconomic status selected were family income, maternal education and paternal occupational status. Pregnancy outcomes considered were preterm delivery, low birthweight, low birthweight for gestational age, and perinatal death. Subsidiary analyses were also undertaken for Apgar scores, time to establish respiration, need for mechanical respiration and admission to intensive care. Before adjustment, the main consistent association was between the occupational status of the father and three measures of perinatal morbidity. Initial adjustment for the mother's socio-demographic background and weight/height ratio reduced the strength and statistical significance of the above associations, while further adjustment for lifestyle variations between the three status groups further reduced the above associations to marginal statistical significance. The findings suggest that observed class differences in pregnancy outcome are attributable to the mother's personal characteristics (height/weight 2 , parity) and her lifestyle.
Ethnic Variations in Severe Maternal Morbidity in the UK– A Case Control Study
Background: Previous studies showed a higher risk of maternal morbidity amongst black and other minority ethnic (BME) groups, but were unable to investigate whether this excess risk was concentrated within specific BME groups in the UK. Our aim was to analyse the specific risks and to investigate reasons for any disparity.
Sociodemographic determinants of pregnancy outcome: a hospital based study
International Journal of Medical Science and Public Health, 2016
Background: Though pregnancy and child birth are natural processes, they are not by any means risk free. In spite of various efforts made to improve the maternal child health (MCH) services, the poor outcome of pregnancy continues to remain high because of complex web of causal factors that includes medical, obstetrics and socioeconomic factors. Objective: To study the association between the sociodemographic factors in pregnant women and adverse pregnancy outcomes and to study certain socioeconomic profile of study group and their association with pregnancy outcome. Materials and Methods: A cross-sectional study was conducted among the all pregnant women reporting in tertiary care hospital for delivery over a period of one calendar year and relevant data were recorded. Result: Of the total 629 women, 288(38.32%) had experienced poor pregnancy outcome. After univariate analysis highly significant association of pregnancy outcome was observed within education, nature of work, socioeconomic status, age at marriage, consanguineous marriage, significant association was observed with maternal age, residence and no significant association was observed with type of family, transport facilities. Conclusion: Poor outcome of pregnancy was maximum in illiterate women, women who were doing moderate-to-heavy work during pregnancy, lower socioeconomic class, women who were married before the age of 18 years and women who gave history of consanguineous marriage.
BMC pregnancy and childbirth, 2015
Suboptimal maternal health conditions (such as obesity, underweight, depression and stress) and health behaviours (such as smoking, alcohol consumption and unhealthy nutrition) during pregnancy have been associated with negative pregnancy outcomes. Our first aim was to give an overview of the self-reported health status and health behaviours of pregnant women under midwife-led primary care in the Netherlands. Our second aim was to identify potential differences in these health status indicators and behaviours according to educational level (as a proxy for socio-economic status) and ethnicity (as a proxy for immigration status). Our cross-sectional study (data obtained from the DELIVER multicentre prospective cohort study conducted from September 2009 to March 2011) was based on questionnaires about maternal health and prenatal care, which were completed by 6711 pregnant women. The relationships of education and ethnicity with 13 health status indicators and 10 health behaviours duri...
Asian Journal of Pharmaceutical and Clinical Research, 2021
Objective: The objective of the study was to determine the association of maternal characteristics with complications of pregnancy among middle socioeconomic women. Methods: The enrolled subjects were divided into two groups as complicated and uncomplicated group based on the occurrence of complications in current pregnancy and their sociodemographic details along with present and past medical and medication history was collected. Results: The mean age of the study subjects was 25.33±4.22 years. Maternal characteristics such as age, parity, body mass index, maternal education, and employment status did not have a statistically significant association with the complications of pregnancy at p<0.05. However, the first antenatal visit at the gestational age <8 weeks had a statistically significant association with the complications of pregnancy at p=0.02. Conclusion: Early initiation of antenatal care along with adequate antenatal visits may reduce the risk of complications of pregnancy.
Incidence and Predictors of Severe Obstetric Morbidity: Case-Control Study
Obstetrical & Gynecological Survey, 2002
Objective To estimate the incidence and predictors of severe obstetric morbidity. Design Development of definitions of severe obstetric morbidity by literature review. Case-control study from a defined delivery population with four randomly selected pregnant women as controls for every case. Setting All 19 maternity units within the South East Thames region and six neighbouring hospitals caring for pregnant women from the region between 1 March 1997 and 28 February 1998. Participants 48 865 women who delivered during the time frame. Results There were 588 cases of severe obstetric morbidity giving an incidence of 12.0/1000 deliveries (95% confidence interval 11.2 to 13.2). During the study there were five maternal deaths attributed to conditions studied. Disease specific morbidities per 1000 deliveries were 6.7 (6.0 to 7.5) for severe haemorrhage, 3.9 (3.3 to 4.5) for severe pre-eclampsia, 0.2 (0.1 to 0.4) for eclampsia, 0.5 (0.3 to 0.8) for HELLP (Haemolysis, Elevated Liver enzymes, and Low Platelets) syndrome, 0.4 (0.2 to 0.6) for severe sepsis, and 0.2 (0.1 to 0.4) for uterine rupture. Age over 34 years, non-white ethnic group, past or current hypertension, previous postpartum haemorrhage, delivery by emergency caesarean section, antenatal admission to hospital, multiple pregnancy, social exclusion, and taking iron or anti-depressants at antenatal booking were all independently associated with morbidity after adjustment. Conclusion Severe obstetric morbidity and its relation to mortality may be more sensitive measures of pregnancy outcome than mortality alone. Most events are related to obstetric haemorrhage and severe pre-eclampsia. Caesarean section quadruples the risk of morbidity. Development and evaluation of ways of predicting and reducing risk are required with particular emphasis paid on the management of haemorrhage and pre-eclampsia.
Journal of Epidemiology & Community Health, 2012
Background Socioeconomic inequalities in health outcomes are dynamic and vary over time. Differences between countries can provide useful insights into the causes of health inequalities. The study aims to compare the associations between two measures of socioeconomic position (SEP)dmaternal education and family incomedand maternal and infant health outcomes between ALSPAC and Pelotas cohorts. Methods Birth cohort studies were started in Avon, UK, in 1991 (ALSPAC) and in the city of Pelotas, Brazil, in 1982. Maternal outcomes included smoking during pregnancy, caesarean section and delivery not attended by a doctor. Infant outcomes were preterm birth, intra-uterine growth restriction (IUGR) and breast feeding for <3 months. The relative index of inequality was used for each measure of SEP so that results were comparable between cohorts. Results An inverse association (higher prevalence among the poorest and less educated) was observed for almost all outcomes, with the exception of caesarean sections where a positive association was found. Stronger incomerelated inequalities for smoking and education-related inequalities for breast feeding were found in the ALSPAC study. However, greater inequalities in caesarean section and education-related inequalities in preterm birth were observed in the Pelotas cohorts. Conclusions Mothers and infants have more adverse health outcomes if they are from poorer and less welleducated socioeconomic backgrounds in both Brazil and the UK. However, our findings demonstrate the dynamic nature of the association between SEP and health outcomes. Examining differential socioeconomic patterning of maternal and infant health outcomes might help understanding of mechanisms underlying such inequalities.
Background: The rates of receipt of postnatal care vary widely between high and low-middle income countries. This study aimed to examine the association between indicators of socioeconomic status during pregnancy and gynecological appointment at any time after childbirth (GA). Methods: a prospective cohort study with pregnant women recruited from 10 primary care clinics of the public sector in the city of São Paulo, Brazil. Socioeconomic characteristics and obstetric information were obtained through a questionnaire administered during pregnancy and in the postpartum period. Adjusted risk ratios (RR) with 95 % confidence intervals (CI) were calculated using Poisson regression.
BMC Public Health, 2011
Background: Caesarean section rates have risen over the last 20 years. Elective Caesarean section rates have been shown to be linked to area deprivation in England, women in the most deprived areas were less likely to have an elective section than those in the most affluent areas. We examine whether individual social class, area deprivation or both are related to Caesarean sections in Scotland and investigate changes over time. Methods: Routine maternity discharge data from live singleton births in Scottish hospitals from three time periods were used; 1980-81 (n = 133,555), 1990-91 (n = 128,933) and 1999-2000 (n = 102,285). Multilevel logistic regression, with 3 levels (births, postcode sector and Health Board) was used to analyse emergency and elective Caesareans separately; analysis was further stratified by previous Caesarean section. The relative index of inequality (RII) was used to assess socioeconomic inequalities.