John W Snelgrove1, Kellie E Murphy1,2. 1. Department of Obstetrics and Gynecology, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada. 2. Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Mt. Sinai Hospital, Toronto, Ontario, Canada.
Abstract
OBJECTIVE: To examine the association between social inequalities and preterm birth, testing both psychosocial and material determinants. DESIGN: Retrospective cohort study with linked hospital data. SETTING AND POPULATION: 17 285 women in England, Scotland, Northern Ireland and Wales giving birth to singletons included in wave 1 of the UK Millennium Cohort Study. METHODS: Social inequalities were measured with material (household income, housing tenure) and psychosocial (education, occupational class, employment, social support) indicators. Analysis using multivariable logistic regression assessed odds of preterm birth, adjusting for demographics, health and health-related behaviors, pregnancy and delivery conditions, and pregnancy complications. MAIN OUTCOME MEASURE: Preterm birth between 24 and 36 weeks, 6 days' gestation. RESULTS: Initial bivariable analysis suggested associations between preterm birth and household income, housing tenure, and education. These effects were largely explained by adjustment for other social determinants in multivariable models. Following full adjustment, effects of unemployment [OR = 1.52, 95% confidence interval (CI) 1.21-1.90, p < 0.001] and one indicator of poor social support (OR = 1.17, 95% CI 1.01-1.35, p = 0.04) remained significant. CONCLUSION: Unemployment and lack of social support are associated with higher risk of preterm birth, supporting the hypothesis that poor psychosocial circumstances elevate a woman's risk of this adverse perinatal outcome. Further research is needed to examine the causal pathways through which social inequalities affect preterm birth.
OBJECTIVE: To examine the association between social inequalities and preterm birth, testing both psychosocial and material determinants. DESIGN: Retrospective cohort study with linked hospital data. SETTING AND POPULATION: 17 285 women in England, Scotland, Northern Ireland and Wales giving birth to singletons included in wave 1 of the UK Millennium Cohort Study. METHODS: Social inequalities were measured with material (household income, housing tenure) and psychosocial (education, occupational class, employment, social support) indicators. Analysis using multivariable logistic regression assessed odds of preterm birth, adjusting for demographics, health and health-related behaviors, pregnancy and delivery conditions, and pregnancy complications. MAIN OUTCOME MEASURE: Preterm birth between 24 and 36 weeks, 6 days' gestation. RESULTS: Initial bivariable analysis suggested associations between preterm birth and household income, housing tenure, and education. These effects were largely explained by adjustment for other social determinants in multivariable models. Following full adjustment, effects of unemployment [OR = 1.52, 95% confidence interval (CI) 1.21-1.90, p < 0.001] and one indicator of poor social support (OR = 1.17, 95% CI 1.01-1.35, p = 0.04) remained significant. CONCLUSION: Unemployment and lack of social support are associated with higher risk of preterm birth, supporting the hypothesis that poor psychosocial circumstances elevate a woman's risk of this adverse perinatal outcome. Further research is needed to examine the causal pathways through which social inequalities affect preterm birth.
Authors: Jennifer L Beauregard; Carolyn Drews-Botsch; Jessica M Sales; W Dana Flanders; Michael R Kramer Journal: Pediatrics Date: 2017-12-14 Impact factor: 7.124
Authors: Rodrigo B Mansur; Graccielle R Cunha; Elson Asevedo; André Zugman; Maiara Zeni-Graiff; Adiel C Rios; Sumit Sethi; Pawan K Maurya; Mateus L Levandowski; Ary Gadelha; Pedro M Pan; Laura Stertz; Síntia I Belangero; Márcia Kauer-Sant' Anna; Antônio L Teixeira; Jair J Mari; Luis A Rohde; Euripedes C Miguel; Roger S McIntyre; Rodrigo Grassi-Oliveira; Rodrigo A Bressan; Elisa Brietzke Journal: PLoS One Date: 2016-08-04 Impact factor: 3.240
Authors: Natalie A Strobel; Sue Peter; Kimberley E McAuley; Daniel R McAullay; Rhonda Marriott; Karen M Edmond Journal: BMJ Open Date: 2017-01-18 Impact factor: 2.692
Authors: Mary Barker; Janis Baird; Tannaze Tinati; Christina Vogel; Sofia Strömmer; Taylor Rose; Rufia Begum; Megan Jarman; Jenny Davies; Sue Thompson; Liz Taylor; Hazel Inskip; Cyrus Cooper; Don Nutbeam; Wendy Lawrence Journal: Healthcare (Basel) Date: 2017-03-20