Association between socioeconomic status with pregnancy and neonatal outcomes: An international multicenter cohort

Gillian M. Maher; Liam J. Ward; Leah Hernandez; Marius Kublickas; Johannes J. Duvekot; Fergus P. McCarthy; Ali S. Khashan; Karolina Kublickiene

doi:10.1111/aogs.14659

Association between socioeconomic status with pregnancy and neonatal outcomes: An international multicenter cohort

Gillian M. Maher^*
, Liam J. Ward
, Leah Hernandez
, Marius Kublickas
, Johannes J. Duvekot
, Fergus P. McCarthy
, Ali S. Khashan
, Karolina Kublickiene

^*Corresponding author for this work

Obstetrics & Gynecology

University College Cork
Karolinska Institutet
National Board of Forensic Medicine
Karolinska University Hospital

Research output: Contribution to journal › Article › Academic › peer-review

31 Citations (Scopus)

264 Downloads (Pure)

Abstract

Introduction: Previous evidence examining the association between socioeconomic status and pregnancy complications are conflicted and often limited to using area-based measures of socioeconomic status. In this study, we aimed to examine the association between individual-level socioeconomic factors and a wide range of adverse pregnancy and neonatal outcomes using data from the IMPROvED birth cohort conducted in Sweden, the Netherlands and Republic of Ireland. Material and methods: The study cohort consisted of women who participated in the IMPROvED birth cohort between 2013 and 2017. Data on socioeconomic factors were self-reported and obtained at 15 weeks' gestation, and included level of education, employment status, relationship status, and income. Data on pregnancy and neonatal outcomes included gestational hypertension, pre-eclampsia, gestational diabetes mellitus, emergency cesarean section, preterm birth, post term delivery, small for gestational age and Apgar score at 1 min. These data were obtained within 72 h following delivery and confirmed using medical records. Multivariable logistic regression examined the association between each socioeconomic variable and each outcome separately adjusting for maternal age, maternal body mass index, maternal smoking, maternal alcohol consumption and cohort center. We also examined the effect of exposure to any ≥2 risk factors compared to none. Results: A total of 2879 participants were included. Adjusted results suggested that those with less than third level of education had an increased odds of gestational hypertension (OR: 1.74, 95% CI: 1.23–2.46), while those on a middle level of income had a reduced odds of emergency cesarean section (OR: 0.59, 95% CI: 0.42–0.84). No significant associations were observed between socioeconomic variables and neonatal outcomes. Exposure to any ≥2 socioeconomic risk factors was associated with an increased risk of preterm birth (OR: 1.75, 95% CI: 1.06–2.89). Conclusions: We did not find strong evidence of associations between individual-level socioeconomic factors and pregnancy and neonatal outcomes in high-income settings overall, with only few significant associations observed among pregnancy outcomes.

Original language	English
Pages (from-to)	1459-1468
Number of pages	10
Journal	Acta Obstetricia et Gynecologica Scandinavica
Volume	102
Issue number	11
Early online date	21 Aug 2023
DOIs	https://doi.org/10.1111/aogs.14659
Publication status	Published - Nov 2023

Bibliographical note

Funding Information:
We are grateful to the IMPROvED team, including all country overall original principal investigators and country specific investigators (in University College Cork, Ireland; Keele University, University of Liverpool and University Center Shrewsbury, UK; Erasmus Medical Center, the Netherlands; Karolinska Institutet, Sweden, and University of Cologne, Germany), as well as the team of trained midwifes and researchers involved in study recruitment, and collection of all data relevant for the study. We also want to acknowledge Lina Benson, Statistician at the Department of Medicine Solna at Karolinska Institutet for initial advice and discussions around Swedish data analysis and presentation.

Publisher Copyright:
© 2023 The Authors. Acta Obstetricia et Gynecologica Scandinavica published by John Wiley & Sons Ltd on behalf of Nordic Federation of Societies of Obstetrics and Gynecology (NFOG).

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

SDG 3 Good Health and Well-being

Access to Document

10.1111/aogs.14659Licence: CC BY-NC

Acta Obstet Gynecol Scand - 2023 - MaherFinal published version, 677 KBLicence: CC BY-NC

Cite this

@article{499016cee46f4f83b299798e3b12db24,

title = "Association between socioeconomic status with pregnancy and neonatal outcomes: An international multicenter cohort",

abstract = "Introduction: Previous evidence examining the association between socioeconomic status and pregnancy complications are conflicted and often limited to using area-based measures of socioeconomic status. In this study, we aimed to examine the association between individual-level socioeconomic factors and a wide range of adverse pregnancy and neonatal outcomes using data from the IMPROvED birth cohort conducted in Sweden, the Netherlands and Republic of Ireland. Material and methods: The study cohort consisted of women who participated in the IMPROvED birth cohort between 2013 and 2017. Data on socioeconomic factors were self-reported and obtained at 15 weeks' gestation, and included level of education, employment status, relationship status, and income. Data on pregnancy and neonatal outcomes included gestational hypertension, pre-eclampsia, gestational diabetes mellitus, emergency cesarean section, preterm birth, post term delivery, small for gestational age and Apgar score at 1 min. These data were obtained within 72 h following delivery and confirmed using medical records. Multivariable logistic regression examined the association between each socioeconomic variable and each outcome separately adjusting for maternal age, maternal body mass index, maternal smoking, maternal alcohol consumption and cohort center. We also examined the effect of exposure to any ≥2 risk factors compared to none. Results: A total of 2879 participants were included. Adjusted results suggested that those with less than third level of education had an increased odds of gestational hypertension (OR: 1.74, 95\% CI: 1.23–2.46), while those on a middle level of income had a reduced odds of emergency cesarean section (OR: 0.59, 95\% CI: 0.42–0.84). No significant associations were observed between socioeconomic variables and neonatal outcomes. Exposure to any ≥2 socioeconomic risk factors was associated with an increased risk of preterm birth (OR: 1.75, 95\% CI: 1.06–2.89). Conclusions: We did not find strong evidence of associations between individual-level socioeconomic factors and pregnancy and neonatal outcomes in high-income settings overall, with only few significant associations observed among pregnancy outcomes.",

author = "Maher, \{Gillian M.\} and Ward, \{Liam J.\} and Leah Hernandez and Marius Kublickas and Duvekot, \{Johannes J.\} and McCarthy, \{Fergus P.\} and Khashan, \{Ali S.\} and Karolina Kublickiene",

note = "Funding Information: We are grateful to the IMPROvED team, including all country overall original principal investigators and country specific investigators (in University College Cork, Ireland; Keele University, University of Liverpool and University Center Shrewsbury, UK; Erasmus Medical Center, the Netherlands; Karolinska Institutet, Sweden, and University of Cologne, Germany), as well as the team of trained midwifes and researchers involved in study recruitment, and collection of all data relevant for the study. We also want to acknowledge Lina Benson, Statistician at the Department of Medicine Solna at Karolinska Institutet for initial advice and discussions around Swedish data analysis and presentation. Publisher Copyright: {\textcopyright} 2023 The Authors. Acta Obstetricia et Gynecologica Scandinavica published by John Wiley \& Sons Ltd on behalf of Nordic Federation of Societies of Obstetrics and Gynecology (NFOG).",

year = "2023",

month = nov,

doi = "10.1111/aogs.14659",

language = "English",

volume = "102",

pages = "1459--1468",

journal = "Acta Obstetricia et Gynecologica Scandinavica",

issn = "0001-6349",

publisher = "Wiley-Blackwell",

number = "11",

}

TY - JOUR

T1 - Association between socioeconomic status with pregnancy and neonatal outcomes

T2 - An international multicenter cohort

AU - Maher, Gillian M.

AU - Ward, Liam J.

AU - Hernandez, Leah

AU - Kublickas, Marius

AU - Duvekot, Johannes J.

AU - McCarthy, Fergus P.

AU - Khashan, Ali S.

AU - Kublickiene, Karolina

N1 - Funding Information: We are grateful to the IMPROvED team, including all country overall original principal investigators and country specific investigators (in University College Cork, Ireland; Keele University, University of Liverpool and University Center Shrewsbury, UK; Erasmus Medical Center, the Netherlands; Karolinska Institutet, Sweden, and University of Cologne, Germany), as well as the team of trained midwifes and researchers involved in study recruitment, and collection of all data relevant for the study. We also want to acknowledge Lina Benson, Statistician at the Department of Medicine Solna at Karolinska Institutet for initial advice and discussions around Swedish data analysis and presentation. Publisher Copyright: © 2023 The Authors. Acta Obstetricia et Gynecologica Scandinavica published by John Wiley & Sons Ltd on behalf of Nordic Federation of Societies of Obstetrics and Gynecology (NFOG).

PY - 2023/11

Y1 - 2023/11

N2 - Introduction: Previous evidence examining the association between socioeconomic status and pregnancy complications are conflicted and often limited to using area-based measures of socioeconomic status. In this study, we aimed to examine the association between individual-level socioeconomic factors and a wide range of adverse pregnancy and neonatal outcomes using data from the IMPROvED birth cohort conducted in Sweden, the Netherlands and Republic of Ireland. Material and methods: The study cohort consisted of women who participated in the IMPROvED birth cohort between 2013 and 2017. Data on socioeconomic factors were self-reported and obtained at 15 weeks' gestation, and included level of education, employment status, relationship status, and income. Data on pregnancy and neonatal outcomes included gestational hypertension, pre-eclampsia, gestational diabetes mellitus, emergency cesarean section, preterm birth, post term delivery, small for gestational age and Apgar score at 1 min. These data were obtained within 72 h following delivery and confirmed using medical records. Multivariable logistic regression examined the association between each socioeconomic variable and each outcome separately adjusting for maternal age, maternal body mass index, maternal smoking, maternal alcohol consumption and cohort center. We also examined the effect of exposure to any ≥2 risk factors compared to none. Results: A total of 2879 participants were included. Adjusted results suggested that those with less than third level of education had an increased odds of gestational hypertension (OR: 1.74, 95% CI: 1.23–2.46), while those on a middle level of income had a reduced odds of emergency cesarean section (OR: 0.59, 95% CI: 0.42–0.84). No significant associations were observed between socioeconomic variables and neonatal outcomes. Exposure to any ≥2 socioeconomic risk factors was associated with an increased risk of preterm birth (OR: 1.75, 95% CI: 1.06–2.89). Conclusions: We did not find strong evidence of associations between individual-level socioeconomic factors and pregnancy and neonatal outcomes in high-income settings overall, with only few significant associations observed among pregnancy outcomes.

AB - Introduction: Previous evidence examining the association between socioeconomic status and pregnancy complications are conflicted and often limited to using area-based measures of socioeconomic status. In this study, we aimed to examine the association between individual-level socioeconomic factors and a wide range of adverse pregnancy and neonatal outcomes using data from the IMPROvED birth cohort conducted in Sweden, the Netherlands and Republic of Ireland. Material and methods: The study cohort consisted of women who participated in the IMPROvED birth cohort between 2013 and 2017. Data on socioeconomic factors were self-reported and obtained at 15 weeks' gestation, and included level of education, employment status, relationship status, and income. Data on pregnancy and neonatal outcomes included gestational hypertension, pre-eclampsia, gestational diabetes mellitus, emergency cesarean section, preterm birth, post term delivery, small for gestational age and Apgar score at 1 min. These data were obtained within 72 h following delivery and confirmed using medical records. Multivariable logistic regression examined the association between each socioeconomic variable and each outcome separately adjusting for maternal age, maternal body mass index, maternal smoking, maternal alcohol consumption and cohort center. We also examined the effect of exposure to any ≥2 risk factors compared to none. Results: A total of 2879 participants were included. Adjusted results suggested that those with less than third level of education had an increased odds of gestational hypertension (OR: 1.74, 95% CI: 1.23–2.46), while those on a middle level of income had a reduced odds of emergency cesarean section (OR: 0.59, 95% CI: 0.42–0.84). No significant associations were observed between socioeconomic variables and neonatal outcomes. Exposure to any ≥2 socioeconomic risk factors was associated with an increased risk of preterm birth (OR: 1.75, 95% CI: 1.06–2.89). Conclusions: We did not find strong evidence of associations between individual-level socioeconomic factors and pregnancy and neonatal outcomes in high-income settings overall, with only few significant associations observed among pregnancy outcomes.

UR - https://www.scopus.com/pages/publications/85168528759

U2 - 10.1111/aogs.14659

DO - 10.1111/aogs.14659

M3 - Article

C2 - 37602747

AN - SCOPUS:85168528759

SN - 0001-6349

VL - 102

SP - 1459

EP - 1468

JO - Acta Obstetricia et Gynecologica Scandinavica

JF - Acta Obstetricia et Gynecologica Scandinavica

IS - 11

ER -

Association between socioeconomic status with pregnancy and neonatal outcomes: An international multicenter cohort

Abstract

Bibliographical note

UN SDGs

Access to Document

Other files and links

Fingerprint

Cite this