The perception of gestational risk through the lens of social determinants of health: a mixed-methods study.

Abstract

The interpretation of gestational risk is multifactorial. The objective of this study is to analyze the relationship between social determinants of health and the perception of gestational risk among high-risk pregnant women, and to examine how this risk was perceived by postpartum women who experienced high-risk pregnancies. A convergent integrative mixed-methods study was conducted in Uberlândia, Minas Gerais, Brazil, between April 2023 and February 2024. In the quantitative phase, 148 high-risk pregnant women completed instruments addressing social determinants and perceived gestational risk. The second phase consisted of semi-structured interviews with 27 postpartum women, analyzed through French Discourse Analysis. Multiparous women and those who reported alcohol consumption during pregnancy had a higher perception of gestational risk. Experiencing racial prejudice and initiating prenatal care in the early first trimester were associated with a lower perception of risk. Two central discourse blocks were identified: 'From Probability to the Materialization of Gestational Risk,' and 'Fear and Trust as Expressions of Feelings'. Therefore, risk perception was influenced by social determinants, highlighting the role of the healthcare system in mediating these perceptions. The findings emphasize the global need for equitable policies and socially sensitive prenatal care strategies to reduce maternal morbidity.