Educational disparities in perinatal health in Denmark in the first decade of the 21st century: a register-based cohort study

ObjectiveTo investigate socioeconomic differences in six perinatal health outcomes in Denmark in the first decade of the 21st century.DesignA population-based cohort study.SettingDanish national registries.ParticipantsA total of 646 829 live born children and 3076 stillborn children (≥22+0 weeks of gestation) born in Denmark from 2000 to 2009. We excluded children with implausible relations between birth weight and gestational age (n=644), children without information on maternal country of origin (n=138) and implausible values of maternal year of birth (n=36).Main outcome measuresWe investigated the following perinatal health outcomes: stillbirth, neonatal and postneonatal mortality, small-for-gestational age, preterm birth grated into moderate preterm, very preterm and extremely preterm, and congenital anomalies registered in the first year of life.ResultsMaternal educational level was inversely associated with all adverse perinatal outcomes. For all examined outcomes, the risk association displayed a clear gradient across the educational levels. The associations remained after adjustment for maternal age, maternal country of origin and maternal year of birth. Compared with mothers with vocational education, mothers with more than 15 years of education had an adjusted risk ratio for stillbirth of 0.64(95% CI 0.56 to 0.72). The corresponding adjusted risk ratios for neonatal mortality, postneonatal mortality, congenital anomalies, moderate preterm birth and small-for-gestational age were, respectively, 0.79(95% CI 0.67 to 0.93), 0.57(95% CI 0.42 to 0.78), 0.87(95% CI 0.83 to 0.91), 0.80(95% CI 0.77 to 0.83) and 0.83(95% CI 0.81 to 0.85).ConclusionSubstantial educational inequalities in perinatal health were still present in Denmark in the first decade of the 21st century.

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Reduced prevalence of small-for-gestational-age and preterm birth for women of low socioeconomic position: a population-based cohort study comparing antenatal midwifery and physician models of care

BMJ Open ◽

10.1136/bmjopen-2018-022220 ◽

2018 ◽

Vol 8 (10) ◽

pp. e022220 ◽

Cited By ~ 8

Author(s):

Daphne N McRae ◽

Patricia A Janssen ◽

Saraswathi Vedam ◽

Maureen Mayhew ◽

Deborah Mpofu ◽

...

Keyword(s):

British Columbia ◽

Cohort Study ◽

Preterm Birth ◽

Gestational Age ◽

Socioeconomic Position ◽

Small For Gestational Age ◽

Models Of Care ◽

Midwifery Care ◽

Low Socioeconomic ◽

Lower Odds

ObjectiveOur aim was to investigate if antenatal midwifery care was associated with lower odds of small-for-gestational-age (SGA) birth, preterm birth (PTB) or low birth weight (LBW) compared with general practitioner (GP) or obstetrician (OB) models of care for women of low socioeconomic position.SettingThis population-level, retrospective cohort study used province-wide maternity, medical billing and demographic data from British Columbia, Canada.ParticipantsOur study included 57 872 pregnant women, with low socioeconomic position, who: were residents of British Columbia, Canada, carried a singleton fetus, had low to moderate medical/obstetric risk, delivered between 2005 and 2012 and received medical insurance premium assistance.Primary and secondary outcome measuresWe report rates, adjusted ORs (aOR), and 95% CIs for the primary outcome, SGA birth (<the 10th percentile), and secondary outcomes, PTB (<37 weeks’ completed gestation) and LBW (<2500 g).ResultsOur sample included 4705 midwifery patients, 45 114 GP patients and 8053 OB patients. Odds of SGA birth were reduced for patients receiving antenatal midwifery versus GP (aOR 0.71, 95% CI 0.62 to 0.82) or OB care (aOR 0.59, 95% CI 0.50 to 0.69). Odds of PTB were lower for antenatal midwifery versus GP (aOR 0.74, 95% CI 0.63 to 0.86) or OB patients (aOR 0.53, 95% CI 0.45 to 0.62). Odds of LBW were reduced for midwifery versus GP (aOR 0.66, 95% CI 0.53 to 0.82) or OB patients (aOR 0.43, 95% CI 0.34 to 0.54).ConclusionAntenatal midwifery care in British Columbia, Canada, was associated with lower odds of SGA birth, PTB and LBW, for women of low socioeconomic position, compared with physician models of care. Results support the development of policy to ensure antenatal midwifery care is available and accessible for women of low socioeconomic position. Future research is needed to determine the underlying mechanisms linking midwifery care to better birth outcomes for women of low socioeconomic position.

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Spontaneous Preterm Birth and Small for Gestational Age Infants in Women Who Stop Smoking Early in Pregnancy: Prospective Cohort Study

Obstetric Anesthesia Digest ◽

10.1097/01.aoa.0000370503.15340.65 ◽

2010 ◽

Vol 30 (2) ◽

pp. 91-92

Author(s):

L.M. McCowan ◽

G.A. Dekker ◽

E. Chan ◽

A. Stewart ◽

L.C. Chappell ◽

...

Keyword(s):

Cohort Study ◽

Preterm Birth ◽

Prospective Cohort Study ◽

Gestational Age ◽

Small For Gestational Age ◽

Prospective Cohort ◽

Spontaneous Preterm Birth ◽

Stop Smoking ◽

In Pregnancy

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Association of preterm birth and small for gestational age with metabolic outcomes in children and adolescents: A population-based cohort study from Taiwan

Pediatrics & Neonatology ◽

10.1016/j.pedneo.2017.07.007 ◽

2018 ◽

Vol 59 (2) ◽

pp. 147-153 ◽

Cited By ~ 15

Author(s):

Yu-Ting Huang ◽

Hsiang-Yu Lin ◽

Chung-Hsing Wang ◽

Bai-Horng Su ◽

Che-Chen Lin

Keyword(s):

Cohort Study ◽

Preterm Birth ◽

Children And Adolescents ◽

Gestational Age ◽

Small For Gestational Age ◽

Population Based ◽

Metabolic Outcomes

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Pregnancy outcome among HIV-infected women on different antiretroviral therapies in Ethiopia: a cohort study

BMJ Open ◽

10.1136/bmjopen-2018-027344 ◽

2019 ◽

Vol 9 (8) ◽

pp. e027344

Author(s):

Yohannes Ejigu ◽

Jeanette H Magnus ◽

Johanne Sundby ◽

Maria C Magnus

Keyword(s):

Cohort Study ◽

Birth Weight ◽

Preterm Birth ◽

Low Birth Weight ◽

Gestational Age ◽

Small For Gestational Age ◽

Highly Active Antiretroviral Therapy ◽

Addis Ababa ◽

Zidovudine Monotherapy ◽

Increased Risk

ObjectiveThe objective of the study was to compare pregnancy outcomes according to maternal antiretroviral treatment (ART) regimens.DesignA retrospective cohort study.Participants and settingsClinical data was extracted from ART exposed pregnancies of HIV-infected Ethiopian women attending antenatal care follow-up in public health facilities in Addis Ababa between February 2010 and October 2016.OutcomesThe primary outcomes evaluated were preterm birth, low birth weight and small-for-gestational-age.ResultsA total 1663 of pregnancies exposed to ART were included in the analyses. Of these pregnancies, 17% resulted in a preterm birth, 19% in low birth weight and 32% in a small-for-gestational-age baby. Compared with highly active antiretroviral therapy (HAART) initiated during pregnancy, zidovudine monotherapy was less likely to result in preterm birth (adjusted OR 0.35, 95% CI 0.19 to 0.64) and low birth weight (adjusted OR 0.48, 95% CI 0.24 to 0.94). We observed no differential risk of preterm birth, low birth weight and small-for-gestational-age, when comparing women who initiated HAART during pregnancy to women who initiated HAART before conception. The risk for preterm birth was higher in pregnancies exposed to nevirapine-based HAART (adjusted OR 1.44, 95% CI 1.06 to 1.96) compared with pregnancies exposed to efavirenz-based HAART. Comparing nevirapine-based HAART with efavirenz-based HAART indicated no strong evidence of increased risk of low birth weight or small-for-gestational-age.ConclusionsWe observed a higher risk of preterm birth among women who initiated HAART during pregnancy compared with zidovudine monotherapy. Pregnancies exposed to nevirapine-based HAART also had a greater risk of preterm births compared with efavirenz-based HAART.

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