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Kehm RD, Misra DP, Slaughter-Acey JC, Osypuk TL. Measuring the Effect of Neighborhood Racial Segregation on Fetal Growth. West J Nurs Res 2022; 44:5-14. [PMID: 34378455 PMCID: PMC9867910 DOI: 10.1177/01939459211037060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Prior studies of neighborhood racial segregation and intrauterine growth have not accounted for confounding factors in early life. We used the Life-Course Influences on Fetal Environment Study of births to Black women in metropolitan Detroit, 2009-2011, (N = 1,408) to examine whether health and social conditions in childhood and adulthood confound or modify the association of neighborhood segregation (addresses during pregnancy geocoded to census tract racial composition) and gestational age-adjusted birthweight. Before adjusting for covariates, women living in a predominantly (≥75%) Black neighborhood gave birth to 47.3 grams (95% CI: -99.0, 4.4) lighter infants, on average, compared with women living in <75% Black neighborhoods. This association was confounded by adulthood (age at delivery, parity, neighborhood deprivation) and childhood (parental education, neighborhood racial composition) factors and modified by adulthood socioeconomic position. These findings underscore the complex relationship between neighborhood racial segregation and birth outcomes, which would be enhanced through a life course framework.
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Affiliation(s)
- Rebecca D. Kehm
- Division of Epidemiology & Community Health, University of Minnesota School of Public Health, Minneapolis, MN, USA
| | - Dawn P. Misra
- Department of Family Medicine and Public Health Sciences, Wayne State University School of Medicine, Detroit, MI, USA
| | - Jaime C. Slaughter-Acey
- Division of Epidemiology & Community Health, University of Minnesota School of Public Health, Minneapolis, MN, USA
| | - Theresa L. Osypuk
- Division of Epidemiology & Community Health, University of Minnesota School of Public Health, Minneapolis, MN, USA
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Taylor-Robinson D, Lai ETC, Wickham S, Rose T, Norman P, Bambra C, Whitehead M, Barr B. Assessing the impact of rising child poverty on the unprecedented rise in infant mortality in England, 2000-2017: time trend analysis. BMJ Open 2019; 9:e029424. [PMID: 31578197 PMCID: PMC6954495 DOI: 10.1136/bmjopen-2019-029424] [Citation(s) in RCA: 52] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2019] [Revised: 07/12/2019] [Accepted: 07/19/2019] [Indexed: 01/21/2023] Open
Abstract
OBJECTIVE To determine whether there were inequalities in the sustained rise in infant mortality in England in recent years and the contribution of rising child poverty to these trends. DESIGN This is an analysis of trends in infant mortality in local authorities grouped into five categories (quintiles) based on their level of income deprivation. Fixed-effects regression models were used to quantify the association between regional changes in child poverty and regional changes in infant mortality. SETTING 324 English local authorities in 9 English government office regions. PARTICIPANTS Live-born children under 1 year of age. MAIN OUTCOME MEASURE Infant mortality rate, defined as the number of deaths in children under 1 year of age per 100 000 live births in the same year. RESULTS The sustained and unprecedented rise in infant mortality in England from 2014 to 2017 was not experienced evenly across the population. In the most deprived local authorities, the previously declining trend in infant mortality reversed and mortality rose, leading to an additional 24 infant deaths per 100 000 live births per year (95% CI 6 to 42), relative to the previous trend. There was no significant change from the pre-existing trend in the most affluent local authorities. As a result, inequalities in infant mortality increased, with the gap between the most and the least deprived local authority areas widening by 52 deaths per 100 000 births (95% CI 36 to 68). Overall from 2014 to 2017, there were a total of 572 excess infant deaths (95% CI 200 to 944) compared with what would have been expected based on historical trends. We estimated that each 1% increase in child poverty was significantly associated with an extra 5.8 infant deaths per 100 000 live births (95% CI 2.4 to 9.2). The findings suggest that about a third of the increases in infant mortality between 2014 and 2017 can be attributed to rising child poverty (172 deaths, 95% CI 74 to 266). CONCLUSION This study provides evidence that the unprecedented rise in infant mortality disproportionately affected the poorest areas of the country, leaving the more affluent areas unaffected. Our analysis also linked the recent increase in infant mortality in England with rising child poverty, suggesting that about a third of the increase in infant mortality from 2014 to 2017 may be attributed to rising child poverty.
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Affiliation(s)
- David Taylor-Robinson
- Department of Public Health and Policy, University of Liverpool, Liverpool, UK
- Section of Epidemiology, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Eric T C Lai
- Department of Public Health and Policy, University of Liverpool, Liverpool, UK
| | - Sophie Wickham
- Department of Public Health and Policy, University of Liverpool, Liverpool, UK
| | - Tanith Rose
- Department of Public Health and Policy, University of Liverpool, Liverpool, UK
| | - Paul Norman
- School of Geography, University of Leeds, Leeds, UK
| | - Clare Bambra
- Institute of Health and Society, Newcastle University, Newcastle, UK
| | - Margaret Whitehead
- Department of Public Health and Policy, University of Liverpool, Liverpool, UK
| | - Ben Barr
- Department of Public Health and Policy, University of Liverpool, Liverpool, UK
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Luecke E, Cohen AK, Brillante M, Rehkopf DH, Coyle J, Hendrick CE, Abrams B. Similarities in Maternal Weight and Birth Weight Across Pregnancies and Across Sisters. Matern Child Health J 2019; 23:138-147. [PMID: 30032445 DOI: 10.1007/s10995-018-2602-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Objectives The current study examined how prepregnancy body mass index (BMI), gestational weight gain, and birth weight cluster between births within women and between women who are sisters. Methods Using data from the National Longitudinal Survey of Youth 1979 cohort, we utilized nested, multivariable hierarchical linear models to examine the correlation of these three outcomes between births (n = 6006) to women (n = 3605) and sisters (n = 3170) so that we can quantify the clustering by sibship and by woman for these three pregnancy-related outcomes. Results After controlling for confounding covariates, prepregnancy BMI (intraclass correlation (ICC) 0.24, 95% CI 0.16, 0.32), gestational weight gain (ICC 0.23, 95% CI 0.16, 0.31), and infant's birthweight (ICC 0.07, 95% CI 0.003, 0.13) were correlated between sisters. Additionally, all three outcomes were significantly correlated between births for each sister, suggesting that prepregnancy BMI (ICC 0.82, 95% CI 0.81, 0.83), gestational weight gain (ICC 0.45, 95% CI 0.42, 0.49), and birth weight (ICC 0.31, 95% CI 0.28, 0.35) track between pregnancies in the same woman. Conclusions for Practice The observed clustering both within women and between sisters suggests that shared genetic and environmental factors among sisters play a role in pregnancy outcomes above and beyond that of women's own genetic and environmental factors. Findings suggest that asking a woman about her sisters' pregnancy outcomes could provide insight into the possible outcomes for her current pregnancy. Future research should test if collecting such a family history and providing tailored clinical recommendations accordingly would be useful.
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Affiliation(s)
- Ellen Luecke
- RTI International, Women's Global Health Imperative, San Francisco, USA
| | - Alison K Cohen
- Department of Public and Nonprofit Administration, University of San Francisco, San Francisco, CA, USA
| | - Miranda Brillante
- University of California Berkeley School of Public Health, 50 University Hall, Berkeley, CA, 94720, USA
| | - David H Rehkopf
- Division of Primary Care and Population Health, Stanford University School of Medicine, Stanford, USA
| | - Jeremy Coyle
- University of California Berkeley School of Public Health, 50 University Hall, Berkeley, CA, 94720, USA
| | - C Emily Hendrick
- Division of Reproduction and Population Health, University of Wisconsin-Madison School of Medicine and Public Health, Madison, USA
| | - Barbara Abrams
- University of California Berkeley School of Public Health, 50 University Hall, Berkeley, CA, 94720, USA. .,Division of Epidemiology, UC Berkeley School of Public Health, 103 Haviland Hall, Berkeley, CA, 94720, USA.
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Osypuk TL, Slaughter-Acey JC, Kehm RD, Misra DP. Life-course Social Mobility and Reduced Risk of Adverse Birth Outcomes. Am J Prev Med 2016; 51:975-982. [PMID: 27866597 PMCID: PMC5167500 DOI: 10.1016/j.amepre.2016.09.008] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2015] [Revised: 07/21/2016] [Accepted: 09/08/2016] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Higher adult socioeconomic position (SEP) is associated with better birth outcomes. However, few studies incorporate life-course or intergenerational SEP, which may inform etiology and targeted prevention efforts. This study tested whether life-course social mobility from childhood was associated with lower risk of adverse birth outcomes. METHODS Data were from the Life-course Influences of Fetal Environments (LIFE) retrospective cohort study among black women, 2009-2011, in metropolitan Detroit, MI. This study (analyzed in 2014-2016) examined whether social mobility was associated with two primary birth outcomes: small for gestational age (SGA) and preterm birth (PTB). Childhood and adulthood SEP were measured by survey in adulthood, for two constructs, measured ordinally: educational attainment and perceived financial sufficiency (subjective income/wealth). Social mobility was calculated as the difference of adulthood minus childhood SEP. RESULTS In covariate-adjusted Poisson regression models, 1-SD improved educational social mobility from childhood to adulthood was protective for SGA (adjusted risk ratio=0.76; 95% CI=0.64, 0.91); this association remained after adjusting for financial mobility. Upward financial social mobility from early childhood was marginally protective for SGA (adjusted risk ratio=0.85; 95% CI=0.72, 1.02), but became nonsignificant after controlling educational mobility. There were no overall associations of social mobility with PTB or low birth weight, although sensitivity analyses identified that improved financial mobility was associated with 16% marginally lower risk of spontaneous PTB and 28% marginally lower risk of low birth weight among upwardly mobile/stable women only. CONCLUSIONS Improved life-course social mobility is associated with reduced risk for SGA and spontaneous PTB among black women.
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Affiliation(s)
- Theresa L Osypuk
- Division of Epidemiology and Community Health, University of Minnesota School of Public Health, Minneapolis, Minnesota.
| | - Jaime C Slaughter-Acey
- Division of Graduate Nursing, College of Nursing and Health Professions, Drexel University, Philadelphia, Pennsylvania
| | - Rebecca D Kehm
- Division of Epidemiology and Community Health, University of Minnesota School of Public Health, Minneapolis, Minnesota
| | - Dawn P Misra
- Department of Family Medicine and Public Health Sciences, Wayne State University School of Medicine, Detroit, Michigan
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Slaughter-Acey JC, Holzman C, Calloway D, Tian Y. Movin' on Up: Socioeconomic Mobility and the Risk of Delivering a Small-for-Gestational Age Infant. Matern Child Health J 2016; 20:613-22. [PMID: 26541591 PMCID: PMC4754152 DOI: 10.1007/s10995-015-1860-5] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Poor fetal growth is associated with increased rates of adverse health outcomes in children and adults. The social determinants of poor fetal growth are not well understood. Using multiple socioeconomic indicators measured at the individual level, this study examined changes in maternal socioeconomic position (SEP) from childhood to adulthood (socioeconomic mobility) in relation to poor fetal growth in offspring. METHODS Data were from the Pregnancy Outcomes and Community Health Study (September 1998-June 2004) that enrolled women in mid-pregnancy from 52 clinics in five Michigan communities (2463 women: 1824 non-Hispanic White, 639 non-Hispanic Black). Fetal growth was defined by birthweight-for-gestational age percentiles; infants with birthweight-for-gestational age <10th percentile were referred to as small-for-gestational age (SGA). In logistic regression models, mothers whose SEP changed from childhood to adulthood were compared to two reference groups, the socioeconomic group they left and the group they joined. RESULTS Approximately, 8.2 % of women (non-Hispanic White: 6.3 %, non-Hispanic Black: 13.9 %) delivered an SGA infant. Upward mobility was associated with decreased risk of delivering an SGA infant. Overall, the SGA adjusted-odds ratio was 0.34 [95 % confidence interval (CI) 0.17-0.69] for women who moved from lower to middle/upper versus static lower class, and 0.44 (CI 0.28-1.04) for women who moved from middle to upper versus static middle class. There were no significant differences in SGA risk when women were compared to the SEP group they joined. CONCLUSIONS Our findings support a link between mother's socioeconomic mobility and SGA offspring. Policies that allow for the redistribution or reinvestment of resources may reduce disparities in rates of SGA births.
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Affiliation(s)
- Jaime C Slaughter-Acey
- College of Nursing and Health Professions, Drexel University, 245 N 15th St, Mailstop 501, Philadelphia, PA, 19102, USA.
| | - Claudia Holzman
- Department of Epidemiology and Biostatistics, College of Human Medicine, Michigan State University, 909 Fee Road Room B601, East Lansing, MI, 48824, USA
| | - Danuelle Calloway
- Department of Epidemiology and Biostatistics, College of Human Medicine, Michigan State University, 909 Fee Road Room B601, East Lansing, MI, 48824, USA
| | - Yan Tian
- Department of Epidemiology and Biostatistics, College of Human Medicine, Michigan State University, 909 Fee Road Room B601, East Lansing, MI, 48824, USA
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Sletner L, Jenum AK, Mørkrid K, Vangen S, Holme IM, Birkeland KI, Nakstad B. Maternal life course socio-economic position and offspring body composition at birth in a multi-ethnic population. Paediatr Perinat Epidemiol 2014; 28:445-54. [PMID: 25060595 DOI: 10.1111/ppe.12137] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Size and body composition at birth may affect long-term health. Mean birthweight and body composition differ between ethnic groups living in Europe. We wanted to explore if this relates to differences in socio-economic conditions in country of origin and over the maternal life course. METHODS This is a population-based cohort study of healthy pregnant women living in Oslo, Norway. Data on maternal early life and present socio-economic position (SEP) were collected in early gestation, and SEP scores were extracted through two separate principal components analyses. The associations between maternal present SEP and four different offspring anthropometric measures at birth were assessed separately, stratified by maternal early life SEP (dichotomised score) and Human Development Index (HDI, a country-level socio-economic indicator) in the country of origin [high HDI (Reference), n = 287 and low HDI, n = 250]. RESULTS A strong positive association between maternal present SEP and offspring birthweight was observed if maternal early life SEP was high, but not if maternal early life SEP was low (P < 0.001 for the interaction term). This interactional effect was observed in both HDI groups. Maternal life course SEP affected offspring birthweight mainly through an effect on length and sum of skin folds. Offspring of mothers with origin from low HDI countries had smaller abdominal circumference, possibly indicating less fat-free mass, regardless of maternal life course SEP. CONCLUSION Our results suggest that there are transgenerational effects of maternal past socio-economic conditions on offspring size and body composition at birth that modify the associations with present socio-economic factors.
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Affiliation(s)
- Line Sletner
- Department of Child and Adolescents Medicine, Akershus University Hospital, Lørenskog, Norway; Institute of Clinical Medicine, University of Oslo, Oslo, Norway; Norwegian Resource Centre for Women's Health, Oslo University Hospital, Oslo, Norway
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Abstract
OBJECTIVE To examine sociodemographic factors, pregnancy-associated psychosocial stress and depression, health risk behaviors, prepregnancy medical and psychiatric illness, pregnancy-related illnesses, and birth outcomes as risk factors for post-partum depression (PPD). METHODS A prospective cohort study screened women at 4 and 8 months of pregnancy and used hierarchical logistic regression analyses to examine predictors of PPD. The study sample include 1,423 pregnant women at a university-based high risk obstetrics clinic. A score of ≥10 on the Patient Health Questionnaire-9 (PHQ-9) indicated clinically significant depressive symptoms. RESULTS Compared with women without significant postpartum depressive symptoms, women with PPD were significantly younger (p<0.0001), more likely to be unemployed (p=0.04), had more pregnancy associated depressive symptoms (p<0.0001) and psychosocial stress (p<0.0001), were more likely to be smokers (p<0.0001), were more likely to be taking antidepressants (ADs) during pregnancy (p=0.002), were less likely to drink any alcohol during pregnancy (p=0.02), and were more likely to have prepregnancy medical illnesses, including diabetes (p=0.02) and neurologic conditions (p=0.02). CONCLUSION Specific sociodemographic and clinical risk factors for PPD were identified that could help physicians target depression case finding for pregnant women.
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Affiliation(s)
- Wayne Katon
- 1 Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine , Seattle, Washington
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Kim D, Saada A. The social determinants of infant mortality and birth outcomes in Western developed nations: a cross-country systematic review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2013; 10:2296-335. [PMID: 23739649 PMCID: PMC3717738 DOI: 10.3390/ijerph10062296] [Citation(s) in RCA: 187] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/03/2013] [Revised: 04/26/2013] [Accepted: 05/16/2013] [Indexed: 11/17/2022]
Abstract
Infant mortality (IM) and birth outcomes, key population health indicators, have lifelong implications for individuals, and are unequally distributed globally. Even among western industrialized nations, striking cross-country and within-country patterns are evident. We sought to better understand these variations across and within the United States of America (USA) and Western Europe (WE), by conceptualizing a social determinants of IM/birth outcomes framework, and systematically reviewing the empirical literature on hypothesized social determinants (e.g., social policies, neighbourhood deprivation, individual socioeconomic status (SES)) and intermediary determinants (e.g., health behaviours). To date, the evidence suggests that income inequality and social policies (e.g., maternal leave policies) may help to explain cross-country variations in IM/birth outcomes. Within countries, the evidence also supports neighbourhood SES (USA, WE) and income inequality (USA) as social determinants. By contrast, within-country social cohesion/social capital has been underexplored. At the individual level, mixed associations have been found between individual SES, race/ethnicity, and selected intermediary factors (e.g., psychosocial factors) with IM/birth outcomes. Meanwhile, this review identifies several methodological gaps, including the underuse of prospective designs and the presence of residual confounding in a number of studies. Ultimately, addressing such gaps including through novel approaches to strengthen causal inference and implementing both health and non-health policies may reduce inequities in IM/birth outcomes across the western developed world.
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Affiliation(s)
- Daniel Kim
- Behavioural and Policy Sciences Department, RAND Corporation, 20 Park Plaza, Suite 920, Boston, MA 02116, USA
- Department of Social and Behavioural Sciences, Ecole des Hautes Etudes en Santé Publique, Rennes 35043, France
| | - Adrianna Saada
- Center for Health Decision Science, Harvard School of Public Health, Boston, MA 02115, USA; E-Mail:
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Rickard IJ, Courtiol A, Prentice AM, Fulford AJC, Clutton-Brock TH, Lummaa V. Intergenerational effects of maternal birth season on offspring size in rural Gambia. Proc Biol Sci 2012; 279:4253-62. [PMID: 22896641 PMCID: PMC3441076 DOI: 10.1098/rspb.2012.1363] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2012] [Accepted: 07/26/2012] [Indexed: 01/10/2023] Open
Abstract
Environmental conditions experienced in early life can influence an individual's growth and long-term health, and potentially also that of their offspring. However, such developmental effects on intergenerational outcomes have rarely been studied. Here we investigate intergenerational effects of early environment in humans using survey- and clinic-based data from rural Gambia, a population experiencing substantial seasonal stress that influences foetal growth and has long-term effects on first-generation survival. Using Fourier regression to model seasonality, we test whether (i) parental birth season has intergenerational consequences for offspring in utero growth (1982 neonates, born 1976-2009) and (ii) whether such effects have been reduced by improvements to population health in recent decades. Contrary to our predictions, we show effects of maternal birth season on offspring birth weight and head circumference only in recent maternal cohorts born after 1975. Offspring birth weight varied according to maternal birth season from 2.85 to 3.03 kg among women born during 1975-1984 and from 2.84 to 3.41 kg among those born after 1984, but the seasonality effect reversed between these cohorts. These results were not mediated by differences in maternal age or parity. Equivalent patterns were observed for offspring head circumference (statistically significant) and length (not significant), but not for ponderal index. No relationships were found between paternal birth season and offspring neonatal anthropometrics. Our results indicate that even in rural populations living under conditions of relative affluence, brief variation in environmental conditions during maternal early life may exert long-term intergenerational effects on offspring.
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Affiliation(s)
- Ian J Rickard
- Department of Animal and Plant Sciences, University of Sheffield, Sheffield S10 2TN, UK.
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Gavin AR, Nurius P, Logan-Greene P. Mediators of adverse birth outcomes among socially disadvantaged women. J Womens Health (Larchmt) 2012; 21:634-42. [PMID: 22150295 PMCID: PMC3366100 DOI: 10.1089/jwh.2011.2766] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Numerous studies find that socially disadvantaged women are more likely than socially advantaged women to deliver infants that weigh less than normal and/or are born weeks prior to their due date. However, little is known about the pathways that link maternal social disadvantage to birth outcomes. Using data from a prospective cohort study, we examined whether antenatal psychosocial stress, substance use, and maternal health conditions in pregnancy mediated the pathway between maternal social disadvantage and birth outcomes. METHODS Analyses used structural equation modeling to examine data from a community clinic-based sample (n=2168) of pregnant women who completed questionnaires assessing psychosocial functioning and health behaviors as well as sociodemographic characteristics, which were matched with subsequent birth outcome data. RESULTS Analyses revealed maternal social disadvantage predicted poorer birth outcomes through a mediated pathway including maternal health conditions in pregnancy. CONCLUSIONS The findings demonstrate that maternal social disadvantage is associated with poor health status in pregnancy, which in turn adversely affects birth outcomes. Results argue for more systematic attention to the roles of social disadvantage, including life course perspectives that trace social disadvantage prior to and through pregnancy.
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Affiliation(s)
- Amelia R Gavin
- School of Social Work, University of Washington, Seattle, WA 98105-6299, USA.
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Gavin AR, Thompson E, Rue T, Guo Y. Maternal early life risk factors for offspring birth weight: findings from the add health study. PREVENTION SCIENCE : THE OFFICIAL JOURNAL OF THE SOCIETY FOR PREVENTION RESEARCH 2012; 13:162-72. [PMID: 21986991 PMCID: PMC4273907 DOI: 10.1007/s11121-011-0253-2] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
The aim of this study was to examine the pathways that link mothers' early life socio economic status (SES) and mothers' experience of childhood maltreatment with birth weight among their later born offspring. Data were drawn from a nationally representative longitudinal survey of school-aged respondents, initially enrolled during adolescence in Wave I (1994-1995) and Wave II (1996) of the National Longitudinal Study of Adolescent Health and followed-up in adulthood in Wave III (2001-2002). Data on offspring birth weight were obtained from nulliparous females (N = 1,897) who had given birth between Waves II and III. Analyses used structural equation modeling to examine the extent to which early life maternal risk predicted offspring birth weight, and demonstrated that maternal childhood SES and maternal childhood maltreatment predicted offspring birth weight through several mediated pathways. First, maternal adolescent substance use and prenatal cigarette use partially mediated the association between maternal childhood SES and offspring birth weight. Second, maternal adolescent depressive symptoms and adult SES partially mediated the association between maternal childhood SES and offspring birth weight. Third, adult SES partially mediated the association between maternal childhood SES and offspring birth weight. Fourth, maternal adolescent substance use and prenatal cigarette use partially mediated the association between maternal childhood maltreatment and offspring birth weight. Finally, maternal adolescent depressive symptoms and adult SES partially mediated the association between maternal childhood maltreatment and offspring birth weight. To our knowledge, this is the first study to identify maternal childhood maltreatment as an early life risk factor for offspring birth weight among a nationally representative sample of young women, and to demonstrate the mechanisms that link childhood SES and maltreatment to offspring birth weight. These findings suggest the importance of designing and implementing prevention and intervention strategies to address early life maternal social conditions in an effort to improve inter generational child health at birth.
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Affiliation(s)
- Amelia R Gavin
- School of Social Work, University of Washington, 4101 15th Avenue NE, Seattle, WA 98105-6299, USA.
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Wilson BL, Gance-Cleveland B, Locus TL. Ethnicity and newborn outcomes: the case of African American women. J Nurs Scholarsh 2011; 43:359-67. [PMID: 21981628 DOI: 10.1111/j.1547-5069.2011.01416.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
PURPOSE Although previous studies have confirmed the relationship between socioeconomic status, ethnicity, education, and occupation on birth outcomes, less is known about the relationship of providers influence or hospital characteristics on birth outcomes for minority women. It is not well understood whether hospital or physician characteristics exert an equal or greater affect compared with maternal sociodemographic factors, particularly for Black childbearing women known to be at particular risk for adverse birth outcomes. DESIGN This retrospective descriptive study sought to determine whether variation in neonatal birth outcomes for Black women was attributable to hospital characteristics, physician influence, or patient sociodemographics. METHODS Fixed and random effects were conducted to empirically determine the relative importance of hospital, physician, and patient characteristics (partitioning the variation of differences in birth outcome to each component) using a large administrative dataset. FINDINGS Considerable variability existed among hospitals over and above hospital ownership or number of hospital beds. CONCLUSIONS Ethnicity was a statistically significant predictor of adverse outcomes, as was the number of prenatal visits and maternal education. There is a significant relationship between adverse newborn outcomes and ethnicity after controlling for hospital and physician characteristics. CLINICAL RELEVANCE Ongoing birth disparities in African American childbearing women are a significant public policy issue with important research and clinical implications. This research adds to nursing knowledge by helping eliminate some factors previously thought to have contributed to the high incidence of perinatal complications for African American women and their newborns.
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Affiliation(s)
- Barbara L Wilson
- Arizona State University College of Nursing and Health Innovation, Center for Improving Health Outcomesin Children, Teens, and Families, Phoenix, AZ 85004, USA.
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Schempf AH, Kaufman JS, Messer LC, Mendola P. The neighborhood contribution to black-white perinatal disparities: an example from two north Carolina counties, 1999-2001. Am J Epidemiol 2011; 174:744-52. [PMID: 21771918 DOI: 10.1093/aje/kwr128] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Previous studies of black-white disparities in perinatal outcomes have generally not controlled for both observed and unobserved neighborhood inequalities with models that compare only black and white women living in the same neighborhoods. Using 1999-2001 birth certificate data from 2 counties in North Carolina, the authors employed a hybrid fixed-effects approach to assess the total contribution of neighborhood factors to both absolute and relative racial disparities in low birth weight, preterm birth (PTB), and smallness for gestational age at term. Neighborhood factors made a notable contribution to racial disparities for PTB only, accounting for an additional 15% reduction in crude disparities beyond individual sociodemographic characteristics, which accounted for approximately 40% of racial disparities. The neighborhood contribution was greater for moderate PTB (32-36 weeks' gestation) than for very PTB (<32 weeks' gestation). A neighborhood deprivation index accounted for a smaller percentage of PTB disparities than the hybrid fixed-effects estimates, which suggests that measured socioeconomic deprivation does not account for all health-relevant neighborhood inequalities. Contemporaneous individual-level sociodemographic and neighborhood factors together explained one- to two-thirds of perinatal disparities. To fully explain racial disparities in perinatal outcomes, evaluation of other differential exposures (e.g., racism or wealth) and neighborhood factors across the life course may be necessary.
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Affiliation(s)
- Ashley H Schempf
- Office of Epidemiology, Policy and Evaluation, Maternal and Child Health Bureau, Health Resources and Services Administration, US Department of Health and Human Services, 5600 Fishers Lane, Room 18-46, Rockville, MD 20857, USA.
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Blumenshine P, Egerter S, Barclay CJ, Cubbin C, Braveman PA. Socioeconomic disparities in adverse birth outcomes: a systematic review. Am J Prev Med 2010; 39:263-72. [PMID: 20709259 DOI: 10.1016/j.amepre.2010.05.012] [Citation(s) in RCA: 540] [Impact Index Per Article: 38.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2009] [Revised: 02/17/2010] [Accepted: 05/27/2010] [Indexed: 10/19/2022]
Abstract
CONTEXT Adverse birth outcomes, such as preterm birth and low birth weight, have serious health consequences across the life course. Socioeconomic disparities in birth outcomes have not been the subject of a recent systematic review. The aim of this study was to systematically review the literature on the association of socioeconomic disadvantage with adverse birth outcomes, with specific attention to the strength and consistency of effects across socioeconomic measures, birth outcomes, and populations. EVIDENCE ACQUISITION Relevant articles published from 1999 to 2007 were obtained through electronic database searches and manual searches of reference lists. English-language studies from industrialized countries were included if (1) study objectives included examination of a socioeconomic disparity in a birth outcome and (2) results were presented on the association between a socioeconomic predictor and a birth outcome related to birth weight, gestational age, or intrauterine growth. Two reviewers extracted data and independently rated study quality; data were analyzed in 2008-2009. EVIDENCE SYNTHESIS Ninety-three of 106 studies reported a significant association, overall or within a population subgroup, between a socioeconomic measure and a birth outcome. Socioeconomic disadvantage was consistently associated with increased risk across socioeconomic measures, birth outcomes, and countries; many studies observed racial/ethnic differences in the effect of socioeconomic measures. CONCLUSIONS Socioeconomic differences in birth outcomes remain pervasive, with substantial variation by racial or ethnic subgroup, and are associated with disadvantage measured at multiple levels (individual/family, neighborhood) and time points (childhood, adulthood), and with adverse health behaviors that are themselves socially patterned. Future reviews should focus on identifying interventions to successfully reduce socioeconomic disparities in birth outcomes.
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Affiliation(s)
- Philip Blumenshine
- Center on Social Disparities in Health, Department of Family and Community Medicine, University of California San Francisco, San Francisco, California 94118, USA
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Braveman P, Barclay C. Health disparities beginning in childhood: a life-course perspective. Pediatrics 2009; 124 Suppl 3:S163-75. [PMID: 19861467 DOI: 10.1542/peds.2009-1100d] [Citation(s) in RCA: 355] [Impact Index Per Article: 23.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
In this article we argue for the utility of the life-course perspective as a tool for understanding and addressing health disparities across socioeconomic and racial or ethnic groups, particularly disparities that originate in childhood. Key concepts and terms used in life-course research are briefly defined; as resources, examples of existing literature and the outcomes covered are provided along with examples of longitudinal databases that have often been used for life-course research. The life-course perspective focuses on understanding how early-life experiences can shape health across an entire lifetime and potentially across generations; it systematically directs attention to the role of context, including social and physical context along with biological factors, over time. This approach is particularly relevant to understanding and addressing health disparities, because social and physical contextual factors underlie socioeconomic and racial/ethnic disparities in health. A major focus of life-course epidemiology has been to understand how early-life experiences (particularly experiences related to economic adversity and the social disadvantages that often accompany it) shape adult health, particularly adult chronic disease and its risk factors and consequences. The strong life-course influences on adult health could provide a powerful rationale for policies at all levels--federal, state, and local--to give more priority to investment in improving the living conditions of children as a strategy for improving health and reducing health disparities across the entire life course.
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Affiliation(s)
- Paula Braveman
- Center on Social Disparities in Health, Department of Family and Community Medicine, University of California, San Francisco, 3333 California St, San Francisco, CA 94118-0943, USA.
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Abstract
Deprivation is associated with poor pregnancy outcome but the role of nutrition as a mediating factor is not well understood. We carried out a prospective cohort study of 1461 singleton pregnancies in Aberdeen, UK during 2000-6. We measured nutrient intake and supplement use, B vitamin and homocysteine status, birth weight, gestational age, neonatal treatment and socio-economic deprivation status. Women in the most deprived deciles were approximately 6 years younger and half as likely to take folic acid supplements periconceptually as the least deprived mothers. Deprivation was associated with low blood folate, high homocysteine and diets low in protein, fibre and many of the vitamins and minerals. The diets of the more deprived women were also characterised by low intakes of fruit, vegetables and oily fish and higher intakes of processed meat, fried potatoes, crisps and snacks. Deprivation was related to preterm birth (OR 1.14 (95 % CI 1.03, 1.25); P = 0.009) and whether the baby required neonatal treatment (OR 1.07 (95 % CI 1.01, 1.14); P = 0.028). Low birth weight was more common in women consuming diets low in vitamin C (OR 0.79 (95 % CI 0.64, 0.97); P = 0.028), riboflavin (OR 0.77 (95 % CI 0.63, 0.93); P = 0.008), pantothenic acid (OR 0.79 (95 % CI 0.65, 0.97); P = 0.023) and sugars (OR 0.78 (95 % CI 0.64, 0.96); P = 0.017) even after adjustment for deprivation index, smoking, marital status and parity. Deprivation in pregnancy is associated with diets poor in specific nutrients and poor diet appears to contribute to inequalities in pregnancy outcome. Improving the nutrient intake of disadvantaged women of childbearing age may potentially improve pregnancy outcome.
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Abstract
A longitudinal birth cohort study is uniquely able to collect information on exposures that antecede signs and symptoms leading to diagnoses, and on the development of neurocognitive and behaviour traits. Here we discuss the optimal time to start such a study, and criteria for inclusion and exclusion of subjects.
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Affiliation(s)
- Jean Golding
- Centre for Child and Adolescent Health, Department of Community Based Medicine, University of Bristol, Bristol, UK.
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Uthman OA, Uthman MB, Yahaya I. A population-based study of effect of multiple birth on infant mortality in Nigeria. BMC Pregnancy Childbirth 2008; 8:41. [PMID: 18783603 PMCID: PMC2551580 DOI: 10.1186/1471-2393-8-41] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2008] [Accepted: 09/10/2008] [Indexed: 11/10/2022] Open
Abstract
Background Multi-foetal pregnancies and multiple births including twins and higher order multiples births such as triplets and quadruplets are high-risk pregnancy and birth. These high-risk groups contribute to the higher rate of childhood mortality especially during early period of life. Methods We examined the relationship between multiple births and infant mortality using univariable and multivariable survival regression procedure with Weibull hazard function, controlling for child's sex, birth order, prenatal care, delivery assistance; mother's age at child birth, nutritional status, education level; household living conditions and several other risk factors. Results Children born multiple births were more than twice as likely to die during infancy as infants born singleton (hazard ratio = 2.19; 95% confidence interval: 1.50, 3.19) holding other factors constant. Maternal education and household asset index were associated with lower risk of infant mortality. Conclusion Multiple births are strongly negatively associated with infant survival in Nigeria independent of other risk factors. Mother's education played a protective role against infant death. This evidence suggests that improving maternal education may be key to improving child survival in Nigeria. A well-educated mother has a better chance of satisfying important factors that can improve infant survival: the quality of infant feeding, general care, household sanitation, and adequate use of preventive and curative health services.
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Affiliation(s)
- Olalekan A Uthman
- Center for Evidence-Based Global Health, Ilorin, Kwara State, Nigeria.
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Odd DE, Doyle P, Gunnell D, Lewis G, Whitelaw A, Rasmussen F. Risk of low Apgar score and socioeconomic position: a study of Swedish male births. Acta Paediatr 2008; 97:1275-80. [PMID: 18489620 PMCID: PMC2582400 DOI: 10.1111/j.1651-2227.2008.00862.x] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Aim The aim of this study was to investigate the association between maternal socioeconomic position and a persistent low Apgar score (a score of < 7 at 1 and 5 min following birth). Methods The research is based on a population cohort study of 183 637 males born in Sweden between 1973 and 1976. Data from the Medical Birth Register were linked to Population and Housing Censuses. Results There was evidence that mothers working in non-manual (Odds ratio (OR) 0.83 (0.72–0.97)) and self-employed (OR 0.64 (0.44–0.93)) occupations were less likely to have an infant with a low Apgar score, compared to manual workers. There was evidence that the risk of a low Apgar score decreased as the mother's level of education increased, if the infant was born by instrumental (OR 0.86 (0.74–0.99)) or caesarean section (OR 0.80 (0.68–0.93)) delivery, but not by unassisted vaginal delivery (OR 1.01 (0.92–1.10)). Conclusion There was a lower risk of poor birth condition in male infants born to more educated and non-manual/self-employed mothers. These differences may contribute to our understanding of socioeconomic differences in infant health and development although the results may not be applicable due to changes over the last 30 years.
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Lahti J, Räikkönen K, Heinonen K, Pesonen AK, Kajantie E, Forsén T, Osmond C, Barker DJP, Eriksson JG. Body size at birth and socio-economic status in childhood: implications for Cloninger's psychobiological model of temperament at age 60. Psychiatry Res 2008; 160:167-74. [PMID: 18573541 DOI: 10.1016/j.psychres.2007.07.016] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2007] [Revised: 07/06/2007] [Accepted: 07/13/2007] [Indexed: 11/24/2022]
Abstract
Small birth size predicts various psychiatric outcomes, including depression. While biologically based temperamental traits may constitute a vulnerability factor for depression, the extent to which birth size predicts these traits in adulthood is not known. We studied, in 1369 women and men identified from a cohort born in 1934-44 in Helsinki, Finland, whether birth size predicts the temperamental traits measured with Cloninger's Tridimensional Personality Questionnaire at an average age of 63 years. Moreover, we examined whether socio-economic status (SES) in childhood modified the associations. Data on birth size were obtained from birth records, and SES in childhood was obtained from school records. Weight and length at birth showed curvilinear, reverse J-shaped effects on harm avoidance (HA), such that the highest HA scores were most characteristic of those born small. Furthermore, high HA was confined to those belonging to a low SES group in childhood regardless of birth size, and to those belonging to the high SES group in childhood if their birth size was small. The associations were independent of several confounders. Since small birth size as well as high HA in adulthood may associate with subsequent depression, our findings might shed light on understanding the early neurodevelopmental processes that predispose to depression through vulnerability characteristics.
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Affiliation(s)
- Jari Lahti
- Department of Psychology, University of Helsinki, Helsinki, Finland.
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Jakobsson K, Mikoczy Z. Reproductive outcome in a cohort of male and female rubber workers: a registry study. Int Arch Occup Environ Health 2008; 82:165-74. [PMID: 18404275 DOI: 10.1007/s00420-008-0318-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2007] [Accepted: 03/12/2008] [Indexed: 11/30/2022]
Abstract
PURPOSE To investigate whether blue-collar employment in the Swedish rubber industry from 1973 onwards had a negative impact on reproductive health. METHODS Pairs of mother and child, and triads of father-mother-child were obtained through linkage of a cohort of 18,518 rubber factory employees with the Swedish Population Registry. Birth outcomes were obtained from the Medical Birth Register for 17,918 children. For each child, parental employment as blue-collar rubber worker during the pregnancy and sperm maturation period was obtained from work-place records. Children to female food industry workers, in all 33,256, constituted an external reference group. RESULTS The sex ratio was reversed, with odds ratio (OR) for having a girl was 1.15 (95% CI 1.02, 1.31) when the mother was exposed. When both parents were exposed, the OR was even higher, 1.28 (95% CI 1.02, 1.62). An increased risk of multiple births was observed when both parents were exposed, with OR 2.42 (95% CI 1.17, 5.01). Children with both maternal and paternal exposure had a reduced birth weight compared to the external reference cohort. After adjustment for smoking (available for births from 1983 onwards), ethnicity and sex, the difference between children (singletons, live births) with maternal and paternal exposure and external referents was -142 g (95% CI -229, -54). The adjusted OR for having a small-for-gestational-age child was 2.15 (95% CI 1.45, 3.18) when the mother was a rubber worker during the pregnancy. CONCLUSION There were clear indications that reproductive outcome was adversely affected in rubber workers. The findings warrant further investigation with refinement of exposure indices and inclusion of other endpoints of reproductive health.
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Affiliation(s)
- Kristina Jakobsson
- Department of Occupational and Environmental Medicine, Lund University Hospital, Lund, Sweden.
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The contribution of maternal working conditions to socio-economic inequalities in birth outcome. Soc Sci Med 2008; 66:1297-309. [DOI: 10.1016/j.socscimed.2007.11.036] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2007] [Indexed: 11/19/2022]
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Odd DE, Rasmussen F, Gunnell D, Lewis G, Whitelaw A. A cohort study of low Apgar scores and cognitive outcomes. Arch Dis Child Fetal Neonatal Ed 2008; 93:F115-20. [PMID: 17916594 PMCID: PMC5141261 DOI: 10.1136/adc.2007.123745] [Citation(s) in RCA: 79] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
OBJECTIVE To investigate the association of brief (0-5 minutes) and prolonged (>5 minutes) low Apgar scores (<7) in non-encephalopathic infants with educational achievement at age 15-16 and intelligence quotients (IQs) at age 18. DESIGN Population-based record-linkage cohort study of 176 524 male infants born throughout Sweden between 1973 and 1976. PATIENTS AND METHODS Data from the Medical Birth Register were linked to Population and Housing Censuses, conscription medical records (IQ), and school registers (summary school grade). Infants were classified according to the time for their Apgar score to reach 7 or above. Premature infants and those with encephalopathy were excluded. RESULTS Infants with brief (OR = 1.14 (1.03-1.27)) or prolonged (OR = 1.35 (1.07-1.69)) low Apgar scores were more likely to have a low IQ score. There was an increased risk of a low IQ score (p = 0.003) the longer it took the infant to achieve a normal Apgar score. There was no association between brief (OR = 0.96 (0.87-1.06)) or prolonged (OR = 1.01 (0.81-1.26)) low Apgar scores and a low summary school grade at age 15-16, or evidence for a trend in the risk of a low school grade (p = 0.61). The estimated proportion with an IQ score below 81 due to transiently low Apgar scores was only 0.7%. CONCLUSIONS Infants in poor condition at birth have increased risk of poor functioning in cognitive tests in later life. This supports the idea of a "continuum of reproductive casualty", although the small individual effect suggests that these mild degrees of fetal compromise are not of clinical importance.
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Affiliation(s)
- D E Odd
- Clinical Science at North Bristol, Paul O'Gorman Lifeline Centre, Southmead Hospital, Bristol BS10 5NB, UK.
| | - F Rasmussen
- Department of Public Health Sciences, Karolinska Institute, Stockholm, Sweden
| | - D Gunnell
- Department of Social Medicine, University of Bristol, Bristol, UK
| | - G Lewis
- Department of Community Medicine, University of Bristol, Bristol, UK
| | - A Whitelaw
- Clinical Science at North Bristol, University of Bristol, Bristol, UK
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Boateng J, Flanagan C. Women's access to health care in Ghana: effects of education, residence, lineage and self-determination. BIODEMOGRAPHY AND SOCIAL BIOLOGY 2008; 54:56-73. [PMID: 19350761 DOI: 10.1080/19485565.2008.9989132] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
Women's physical and psychological access to health care was analyzed using the 2003 Ghana Demographic and Health Survey (GDHS), a nationally representative study for monitoring population and health in Ghana. Female respondents from the 2133 cases in the couple's data set were used in this study. Women's level of education was positively related to physical but not to psychological access to health care. Residing in an urban area was positively related to both types of access. Matriliny consistently showed positive effects on physical access. In addition to these demographic factors, both physical and psychological access were positively related to women's self-determination, i.e., women's right and ability to make real choices about their lives including their health, fertility, sexuality, childcare and all areas where women are denied autonomy and dignity in their identities as women. Self-determination factors both mediated the effects of background factors on access and added explanatory power to the models.
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Affiliation(s)
- John Boateng
- Department of Agricultural and Extension Education, The Pennsylvania State University, University Park Campus, State College, PA 16802-2601, USA
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