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

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Assessing the relationship between adverse pregnancy outcomes and area-level deprivation in Wales 2014-2019 : A national population-based cross-sectional study. / Brown, Heather; Jesurasa, Amrita; Bambra, Clare; Rankin, Judith; McNaughton, Amy; Heslehurst, Nicola.

In: BMJ Open, Vol. 11, No. 11, e052330, 17.11.2021.

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Brown, Heather ; Jesurasa, Amrita ; Bambra, Clare ; Rankin, Judith ; McNaughton, Amy ; Heslehurst, Nicola. / Assessing the relationship between adverse pregnancy outcomes and area-level deprivation in Wales 2014-2019 : A national population-based cross-sectional study. In: BMJ Open. 2021 ; Vol. 11, No. 11.

Bibtex

@article{8c9327ca75a74c14b557c00b300a9e09,
title = "Assessing the relationship between adverse pregnancy outcomes and area-level deprivation in Wales 2014-2019: A national population-based cross-sectional study",
abstract = "Objectives The aim of this study was to assess the relationship between deciles of area-level deprivation and seven adverse pregnancy outcomes in Wales. Design Cross-sectional analysis. Setting 64 699 live births in Wales from 31 March 2014 to 16 September 2019. Primary outcome variable We 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. Results There 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. Conclusions There 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.",
keywords = "obstetrics, public health, reproductive medicine, social medicine",
author = "Heather Brown and Amrita Jesurasa and Clare Bambra and Judith Rankin and Amy McNaughton and Nicola Heslehurst",
year = "2021",
month = nov,
day = "17",
doi = "10.1136/bmjopen-2021-052330",
language = "English",
volume = "11",
journal = "BMJ Open",
issn = "2044-6055",
publisher = "BMJ Publishing Group Ltd",
number = "11",

}

RIS

TY - JOUR

T1 - Assessing the relationship between adverse pregnancy outcomes and area-level deprivation in Wales 2014-2019

T2 - A national population-based cross-sectional study

AU - Brown, Heather

AU - Jesurasa, Amrita

AU - Bambra, Clare

AU - Rankin, Judith

AU - McNaughton, Amy

AU - Heslehurst, Nicola

PY - 2021/11/17

Y1 - 2021/11/17

N2 - Objectives The aim of this study was to assess the relationship between deciles of area-level deprivation and seven adverse pregnancy outcomes in Wales. Design Cross-sectional analysis. Setting 64 699 live births in Wales from 31 March 2014 to 16 September 2019. Primary outcome variable We 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. Results There 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. Conclusions There 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.

AB - Objectives The aim of this study was to assess the relationship between deciles of area-level deprivation and seven adverse pregnancy outcomes in Wales. Design Cross-sectional analysis. Setting 64 699 live births in Wales from 31 March 2014 to 16 September 2019. Primary outcome variable We 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. Results There 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. Conclusions There 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.

KW - obstetrics

KW - public health

KW - reproductive medicine

KW - social medicine

U2 - 10.1136/bmjopen-2021-052330

DO - 10.1136/bmjopen-2021-052330

M3 - Journal article

C2 - 34789495

AN - SCOPUS:85120411528

VL - 11

JO - BMJ Open

JF - BMJ Open

SN - 2044-6055

IS - 11

M1 - e052330

ER -