TY - JOUR

T1 - Socioeconomic inequalities and adverse pregnancy outcomes in the UK and Republic of Ireland

T2 - A systematic review and meta-analysis

AU - Thomson, Katie

AU - Moffat, Malcolm

AU - Arisa, Oluwatomi

AU - Jesurasa, Amrita

AU - Richmond, Catherine

AU - Odeniyi, Adefisayo

AU - Bambra, Clare

AU - Rankin, Judith

AU - Brown, Heather

AU - Bishop, Julie

AU - Wing, Susan

AU - McNaughton, Amy

AU - Heslehurst, Nicola

PY - 2021/3/15

Y1 - 2021/3/15

N2 - Objective There has been an unprecedented rise in infant mortality associated with deprivation in recent years in the United Kingdom (UK) and Republic of Ireland. A healthy pregnancy can have significant impacts on the life chances of children. The objective of this review was to understand the association between individual-level and household-level measures of socioeconomic status and adverse pregnancy outcomes. Design Systematic review and meta-analysis. Data sources Nine databases were searched (Medline, Embase, Scopus, ASSIA, CINAHL, PsycINFO, BNI, MIDRIS and Google Scholar) for articles published between 1999 and August 2019. Grey literature searches were also assessed. Study selection criteria Studies reporting associations between individual-level or household socioeconomic factors on pregnancy outcomes in the UK or Ireland. Results Among the 82 353 search results, 53 821 titles were identified and 35 unique studies met the eligibility criteria. Outcomes reported were neonatal, perinatal and maternal mortality, preterm birth, birth weight and mode of delivery. Pooled effect sizes were calculated using random-effects meta-analysis. There were significantly increased odds of women from lower levels of occupation/social classes compared with the highest level having stillbirth (OR 1.40, 95% CI 1.23 to 1.59, I 2 98.62%), neonatal mortality (OR 1.39, 95% CI 1.22 to 1.57, I 2 97.09%), perinatal mortality (OR 1.39, 95% CI 1.23 to 1.57, I 2 98.69%), preterm birth (OR 1.41, 95% CI 1.33 to 1.50, I 2 70.97%) and low birth weight (OR 1.40, 95% CI 1.19 to 1.61, I 2 99.85%). Limitations relate to available data, unmeasured confounders and the small number of studies for some outcomes. Conclusions This review identified consistent evidence that lower occupational status, especially manual occupations and unemployment, were significantly associated with increased risk of multiple adverse pregnancy outcomes. Strategies to improve pregnancy outcomes should incorporate approaches that address wider determinants of health to provide women and families with the best chances of having a healthy pregnancy and baby and to decrease pregnancy-related health inequalities in the general population. PROSPERO registration number PROSPERO CRD42019140893.

AB - Objective There has been an unprecedented rise in infant mortality associated with deprivation in recent years in the United Kingdom (UK) and Republic of Ireland. A healthy pregnancy can have significant impacts on the life chances of children. The objective of this review was to understand the association between individual-level and household-level measures of socioeconomic status and adverse pregnancy outcomes. Design Systematic review and meta-analysis. Data sources Nine databases were searched (Medline, Embase, Scopus, ASSIA, CINAHL, PsycINFO, BNI, MIDRIS and Google Scholar) for articles published between 1999 and August 2019. Grey literature searches were also assessed. Study selection criteria Studies reporting associations between individual-level or household socioeconomic factors on pregnancy outcomes in the UK or Ireland. Results Among the 82 353 search results, 53 821 titles were identified and 35 unique studies met the eligibility criteria. Outcomes reported were neonatal, perinatal and maternal mortality, preterm birth, birth weight and mode of delivery. Pooled effect sizes were calculated using random-effects meta-analysis. There were significantly increased odds of women from lower levels of occupation/social classes compared with the highest level having stillbirth (OR 1.40, 95% CI 1.23 to 1.59, I 2 98.62%), neonatal mortality (OR 1.39, 95% CI 1.22 to 1.57, I 2 97.09%), perinatal mortality (OR 1.39, 95% CI 1.23 to 1.57, I 2 98.69%), preterm birth (OR 1.41, 95% CI 1.33 to 1.50, I 2 70.97%) and low birth weight (OR 1.40, 95% CI 1.19 to 1.61, I 2 99.85%). Limitations relate to available data, unmeasured confounders and the small number of studies for some outcomes. Conclusions This review identified consistent evidence that lower occupational status, especially manual occupations and unemployment, were significantly associated with increased risk of multiple adverse pregnancy outcomes. Strategies to improve pregnancy outcomes should incorporate approaches that address wider determinants of health to provide women and families with the best chances of having a healthy pregnancy and baby and to decrease pregnancy-related health inequalities in the general population. PROSPERO registration number PROSPERO CRD42019140893.

KW - epidemiology

KW - fetal medicine

KW - maternal medicine

KW - public health

U2 - 10.1136/bmjopen-2020-042753

DO - 10.1136/bmjopen-2020-042753

M3 - Journal article

C2 - 33722867

AN - SCOPUS:85102787149

VL - 11

JO - BMJ Open

JF - BMJ Open

SN - 2044-6055

IS - 3

M1 - e042753

ER -