Alexa M Sassin, Natalie Osterlund, Haleh Sangi-Haghpeykar, Kjersti M Aagaard
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引用次数: 0
Abstract
Objective We aimed to determine the relationships between socioeconomic disadvantage, as measured by the Social Deprivation Index (SDI), and prenatal care (PNC) utilization, obstetrical outcomes, and neonatal complications. Study Design All spontaneously-conceived singleton deliveries of nulliparous gravidae with residence zip code available (n= 4,786) were identified in a population-based database. Deliveries were assigned SDI scores based on preconception zip code. SDI scores (1-100) are a composite measure of seven community demographic characteristics of poverty, education, transportation, employment, and household composition. SDI scores were categorized into quartiles and grouped for analysis [Q1 (n=1,342), Q2+3 (n=1,752), and Q4 (n=1,692)] with higher scores indicative of greater disadvantage. Statistical analysis was performed using a generalized linear mixed method. Results Among our cohort, gravidae in the lowest (least-deprived) SDI quartile (Q1) were older, had lower pre-pregnancy body mass indices, and were more likely to receive PNC from a physician specializing in Obstetrics and Gynecology. Gravidae residing in the highest (most-deprived) SDI quartile (Q4) attended fewer prenatal visits [mean (standard deviation) 11.17 (2.9)] than those living in Q1 [12.04 (2.3), p < 0.0001]. Gravidae in Q4 were less likely to receive sufficient PNC compared to those in Q1 (52 vs. 64.2%, p < 0.0001) and were more likely to fail to achieve appropriate gestational weight gain (GWG) (19.6 in Q4 vs. 15.9% in Q1, p < 0.01). No significant differences in composite maternal (CMM) or neonatal morbidity (CNM) were associated with SDI quartile. Conclusions Outer quartile social deprivation was associated with higher proportions of primigravidae not meeting recommendations for GWG and attending fewer prenatal visits, but it did not affect CMM or CNM. Improving care access and providing nutritional support to all gravidae are likely important steps toward health equity.
期刊介绍:
The American Journal of Perinatology is an international, peer-reviewed, and indexed journal publishing 14 issues a year dealing with original research and topical reviews. It is the definitive forum for specialists in obstetrics, neonatology, perinatology, and maternal/fetal medicine, with emphasis on bridging the different fields.
The focus is primarily on clinical and translational research, clinical and technical advances in diagnosis, monitoring, and treatment as well as evidence-based reviews. Topics of interest include epidemiology, diagnosis, prevention, and management of maternal, fetal, and neonatal diseases. Manuscripts on new technology, NICU set-ups, and nursing topics are published to provide a broad survey of important issues in this field.
All articles undergo rigorous peer review, with web-based submission, expedited turn-around, and availability of electronic publication.
The American Journal of Perinatology is accompanied by AJP Reports - an Open Access journal for case reports in neonatology and maternal/fetal medicine.