scholarly journals Socioeconomic inequalities in birth outcomes: An 11-year analysis in Colombia

PLoS ONE ◽  
2021 ◽  
Vol 16 (7) ◽  
pp. e0255150
Author(s):  
Carol C. Guarnizo-Herreño ◽  
Gabriel Torres ◽  
Giancarlo Buitrago

Objective To examine socioeconomic inequalities in birth outcomes among infants born between 2008 and 2018 and assessed trends in inequalities during that period in Colombia, a middle-income country with high levels of inequality emerging from a long internal armed conflict. Methods Using birth certificate data in Colombia, we analysed the outcomes of low birth weight, an Apgar score <7 at 5 minutes after birth and the number of prenatal visits among full-term pregnancies. Maternal education and health insurance schemes were used as socioeconomic position (SEP) indicators. Inequalities were estimated using the prevalence/mean of the outcomes across categories of the SEP indicators and calculating the relative and slope indices of inequality (RII and SII, respectively). Results Among the 5,433,265 full-term singleton births analysed, there was a slight improvement in the outcomes analysed over the study period (lower low-birth-weight and Apgar<7 prevalence rates and higher number of prenatal visits). We observed a general pattern of social gradients and significant relative (RII) and absolute (SII) inequalities for all outcomes across both SEP indicators. RII and SII estimates with their corresponding CIs revealed a general picture of no significant changes in inequalities over time, with some particular, time-dependent exceptions. When comparing the initial and final years of our study period, inequalities in low birth weight related to maternal education increased while those in Apgar score <7 decreased. Relative inequalities across health insurance schemes increased for the two birth outcomes but decreased for the number of prenatal visits. Conclusion The lack of a consistent improvement in the magnitude of inequalities in birth outcomes over an 11-year period is a worrying issue because it could aggravate the cycle of inequality, given the influence of birth outcomes on health, social and economic outcomes throughout the life course. The findings of our analysis emphasize the importance of policies aimed at providing access to quality education and providing a health care system with universal coverage and high levels of integration.

2019 ◽  
Vol 19 (1) ◽  
Author(s):  
Di Tang ◽  
Xiangdong Gao ◽  
Peter C. Coyte

Abstract Background Despite extensive research concerning the impact of health insurance on the advancement of infant health in developed countries, few studies have adjusted their results for potential confounding due to adverse selection in insurance coverage, wherein those who anticipate a need for health services tend to be the ones that acquire insurance. The presence of compulsory health insurance in China, such as the Urban Employee Basic Medical Insurance (UEBMI) scheme may provide an opportunity to estimate the effect of health insurance on infant health, by reducing the endogeneity problem into insurance due to the adverse selection. The objective is to assess the relationship between UEBMI and infant health outcomes in one sizeable municipal-level obstetrics hospital in Shanghai, East China. Methods Medical records data from the Shanghai First Maternity and Infant Hospital from January 1, 2013 to April 30, 2019 were used to form an analysis dataset of 160,429 live births which was comprised of Shanghai residents with UEBMI coverage (n = 101,153) and women without any insurance coverage (n = 59,276). A propensity score matching approach using conjoint quantile regression and probit regression models was used to eliminate latent endogeneity of UEBMI coverage in order to garner robust results. Further analysis stratified by maternal migrant status was conducted to further assess the sensitivity of the findings to distinct patient subgroups. Results The UEBMI scheme was shown to be associated with improvements in infant birth outcomes. The scheme was associated with: an increase in birth weight of about 30 g (p <  0.001, 95% CI 23.908–35.295). This finding was evident in other five different birth outcomes (premature birth, low birth weight, very low birth weight, low Apgar score, and an abnormal health condition at birth). After stratifying by migrant status, the UEBMI was shown to have a greater effect on migrants compared to local residents of Shanghai. Conclusions Our findings suggest that health insurance coverage for pregnant women, especially for migrants, has the potential to significantly and directly improve infant health outcomes. Further research is required to determine whether these findings can be replicated for other Chinese jurisdictions.


BMJ Open ◽  
2018 ◽  
Vol 8 (12) ◽  
pp. e022946 ◽  
Author(s):  
Natalie C Momen ◽  
Linn Håkonsen Arendt ◽  
Andreas Ernst ◽  
Jørn Olsen ◽  
Jiong Li ◽  
...  

ObjectivesThis study aims to estimate the association between pregnancy-associated maternal cancers, diagnosed both prenatally and postnatally, and birth outcomes.DesignPopulation-based register study.SettingNational registers of Denmark and Sweden.ParticipantsA total of 5 523 365 children born in Denmark (1977–2008) and Sweden (1973–2006).Primary and secondary outcome measures: gestational age, birth weight, size for gestational age, Apgar score, caesarean section and sex were the outcomes of interest. ORs and relative risk ratios (RRR) with 95% CIs were estimated using logistic regression and multinomial logistic regression, respectively.ResultsIn this study, 2% of children were born to mothers with a diagnosis of cancer. Children whose mothers received a prenatal cancer diagnosis had higher risk of being born preterm (RRR: 1.77, 95% CI 1.64 to 1.90); low birth weight (RRR 1.84, 95% CI 1.69 to 2.01); low Apgar score (OR 1.36, 95% CI 1.20 to 1.56); and by caesarean section (OR: 1.69, 95% CI 1.59 to 1.80). Associations moved towards the null for analyses using postnatal diagnoses, but preterm birth (RRR: 1.13, 95% CI 1.09 to 1.17) and low birth weight (RRR: 1.14, 95% CI 1.09 to 1.18) remained statistically significant, while risk of caesarean section became so (OR: 0.95, 95% CI 0.91 to 0.98). Additionally, statistical significance was reached for large for gestational age (RRR: 1.06, 95% CI 1.01 to 1.11), high birth weight (RRR: 1.04, 95% CI 1.01 to 1.06) and caesarean section (OR: 0.95, 95% CI 0.91 to 0.98).ConclusionsResults suggest an association between pregnancy-associated cancers and adverse birth outcomes in the offspring. While this is strongest for prenatally diagnosed cancers, some smaller associations exist for postnatally diagnosed cancers, indicating that cancer itself could affect fetal development, or that cancer and adverse birth outcomes share risk factors. Future studies on maternal cancer during pregnancy should consider including some postnatal years in their exposure window.


2021 ◽  
Author(s):  
Ethar Abdullah

Abstract Low birth weight (delivery of an infant with less than 2500 grams) is owed to two main causes, either IUGR or pre-term delivery. It makes the newborn susceptible to many health issues from birth and through the adulthood life. Whoever IUGR is the leading cause of LBW in developing countries, and hence it is more reliable here in Sudan to study the risk factors that lead to it which are whoever mostly modifiable. This is a hospital based unmatched case-control study. A total of 134 (67 cases and 67 controls) mothers and their full-term newborn infants were included in the study. The participants were interviewed with a questionnaire and anthropometric measurements were obtained at the end of the interview. The data was analyzed using SPSS and Odd ratios of the risk factors were calculated. The main risk factors that found to influence the birth weight of our study participants were lack of maternal education, rural place of residence, bleeding during pregnancy, high blood pressure during pregnancy, inadequate spacing, lack of ANC follow up, not having iron supplementation and exposure to passive smoking during pregnancy.


2019 ◽  
Vol 19 (1) ◽  
Author(s):  
Lauren Dyer ◽  
Rachel Hardeman ◽  
Dovile Vilda ◽  
Katherine Theall ◽  
Maeve Wallace

Abstract Background A growing body of evidence is beginning to highlight how mass incarceration shapes inequalities in population health. Non-Hispanic blacks are disproportionately affected by incarceration and criminal law enforcement, an enduring legacy of a racially-biased criminal justice system with broad health implications for black families and communities. Louisiana has consistently maintained one of the highest rates of black incarceration in the nation. Concurrently, large racial disparities in population health persist. Methods We conducted a cross-sectional analysis of all births among non-Hispanic black women in Louisiana in 2014 to identify associations between parish-level (county equivalent) prevalence of jail incarceration within the black population and adverse birth outcomes (N = 23,954). We fit a log-Poisson model with generalized estimating equations to approximate the relative risk of preterm birth and low birth weight associated with an interquartile range increase in incarceration, controlling for confounders. In sensitivity analyses, we additionally adjusted for the parish-level index crime prevalence and analyzed regression models wherein white incarceration was used to predict the risk of adverse birth outcomes in order to quantify the degree to which mass incarceration may harm health above and beyond living in a high crime area. Results There was a significant 3% higher risk of preterm birth among black women associated with an interquartile range increase in the parish-level incarceration prevalence of black individuals, independent of other factors. Adjusting for the prevalence of index crimes did not substantively change the results of the models. Conclusion Due to the positive significant associations between the prevalence of black individuals incarcerated in Louisiana jails and estimated risk of preterm birth, mass incarceration may be an underlying cause of the persistent inequities in reproductive health outcomes experienced by black women in Louisiana. Not only are there economic and social impacts stemming from mass incarceration, but there may also be implications for population health and health inequities, including the persistence of racial disparities in preterm birth and low birth weight.


2015 ◽  
Vol 2015 ◽  
pp. 1-7 ◽  
Author(s):  
Ravi Kumar Bhaskar ◽  
Krishna Kumar Deo ◽  
Uttam Neupane ◽  
Subhadra Chaudhary Bhaskar ◽  
Birendra Kumar Yadav ◽  
...  

Background. This study was done to assess the maternal and sociodemographic factors associated with low birth weight (LBW) babies.Methods. An unmatched case control study was done involving 159 cases (mothers having LBW singleton babies) and 159 controls (mothers having normal birth weight singleton babies).Results. More than 50% of LBW babies were from the mothers with height ≤145 cm while only 9.43% of NBW babies were from the mothers with that height. Finally, after multivariate logistic regression analysis, maternal height, time of first antenatal care (ANC) visit, number of ANC visits, iron supplementation, calcium supplementation, maternal education, any illness during pregnancy, and hypertension were found as the significant predictors of LBW. However, maternal blood group AB, normal maternal Body Mass Index (BMI), mother’s age of 30 or more years, and starting ANC visit earlier were found to be protective for LBW.Conclusion. Study findings suggest that selectively targeted interventions such as delay age at first pregnancy, improving maternal education and nutrition, and iron and calcium supplementation can prevent LBW in Nepal.


PEDIATRICS ◽  
1977 ◽  
Vol 60 (4) ◽  
pp. 519-530 ◽  
Author(s):  

The goal of feeding regimens for low-birth-weight infants is to obtain a prompt postnatal resumption of growth to a rate approximating intrauterine growth because this is believed to provide the best possible conditions for subsequent normal development. This statement reviews current opinion and practices as well as earlier reviews1-5 of the feeding of the low-birth-weight infant. Caloric Requirement The basal metabolic rate of low-birth-weight infants is lower than that of full-term infants during the first week of life, but it reaches and exceeds that of the full-term infant by the second week. Daily caloric requirements reach 50 to 100 kcal/kg by the end of the first week of life and usually increase to 110 to 150 kcal/kg in subsequent active growth. A partition of the daily minimum energy requirements is shown in Table I.6 There are considerable variations from these average values, depending on both biological and environmental factors. Infants who are small for gestational age tend to have a higher basal metabolic rate than do premature infants of the same weight.7 The degree of physical activity appears to be a characteristic of the individual infant. Environmental factors may have a greater influence than biological variation in determining the total caloric requirements. The maximal response to cold stress can increase the resting rate of heat production up to 2½ times.6Calories expended for specific dynamic action and for fecal losses are dependent on the composition of the milk or formula fed, as well as on individual variations in absorption of


PEDIATRICS ◽  
1965 ◽  
Vol 35 (6) ◽  
pp. 1021-1021
Author(s):  
HOWARD SETLEIS

Having read "Correlates of Low Birth Weight: Psychological Status at Six to Seven Years of Age" by Weiner et al. in the March, 1965, issue of Pediatrics, perhaps the psychological stage was set for pseudo-psychological hypophesizing. I know for a fact that many individuals reading the Summary of the article completely misread the second line. This sentence is printed as: ". . . weight children and 415 full-time children ..." Could the words "full-time" really have been an error? Could the authors, editors, and printers of Pediatrics have forgotten the use of the words "full-term"? Obviously not! "Full-term" as a descriptive classification of infants is used throughout the paper.


1992 ◽  
Vol 81 (11) ◽  
pp. 933-934 ◽  
Author(s):  
G Iacono ◽  
A Carroccio ◽  
G Montalto ◽  
F Cavataio ◽  
RA Gioeli ◽  
...  

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