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Preterm birth and social inequality: assessing the effects of material and psychosocial disadvantage in a UK birth cohort
Ist Teil von
Acta obstetricia et gynecologica Scandinavica, 2015-07, Vol.94 (7), p.766-775
Ort / Verlag
United States: Blackwell Publishing Ltd
Erscheinungsjahr
2015
Link zum Volltext
Quelle
Wiley Online Library Journals Frontfile Complete
Beschreibungen/Notizen
Objective
To examine the association between social inequalities and preterm birth, testing both psychosocial and material determinants.
Design
Retrospective cohort study with linked hospital data.
Setting and population
17 285 women in England, Scotland, Northern Ireland and Wales giving birth to singletons included in wave 1 of the UK Millennium Cohort Study.
Methods
Social inequalities were measured with material (household income, housing tenure) and psychosocial (education, occupational class, employment, social support) indicators. Analysis using multivariable logistic regression assessed odds of preterm birth, adjusting for demographics, health and health‐related behaviors, pregnancy and delivery conditions, and pregnancy complications.
Main outcome measure
Preterm birth between 24 and 36 weeks, 6 days' gestation.
Results
Initial bivariable analysis suggested associations between preterm birth and household income, housing tenure, and education. These effects were largely explained by adjustment for other social determinants in multivariable models. Following full adjustment, effects of unemployment [OR = 1.52, 95% confidence interval (CI) 1.21–1.90, p < 0.001] and one indicator of poor social support (OR = 1.17, 95% CI 1.01–1.35, p = 0.04) remained significant.
Conclusion
Unemployment and lack of social support are associated with higher risk of preterm birth, supporting the hypothesis that poor psychosocial circumstances elevate a woman's risk of this adverse perinatal outcome. Further research is needed to examine the causal pathways through which social inequalities affect preterm birth.