Influence of maternal age, parity and social class on perinatal mortality in Scotland: 1960-82

Maternal age at birth and neonatal mortality: Associations from 67 low-income and middle-income countries

BACKGROUND

Both young and advanced maternal age have been associated with higher risks of neonatal mortality, but most studies are from high-income countries and the evidence from low- and middle-income countries (LMICs) is scarce.

OBJECTIVE

To investigate the association between maternal age at delivery and neonatal mortality in LMICs.

METHODS

This is a cross-sectional study using data from 159 Demographic and Health Surveys in 67 LMICs between 2000 and 2018. Maternal age at the time of the birth was the exposure variable, and neonatal mortality was the outcome. Multivariable logistic regression model taking into consideration complex survey design was performed with adjustments for maternal education level, paternal education level, rural/urban residence, country, and survey year. Subgroup analyses were performed by time of death, sex, the country's World Bank income classification, the World Health Organization region, and survey year.

RESULTS

A total of 1 395 746 mother-neonate pairs were included. Overall, compared with neonates born to mothers aged 25-29 years, those born to younger mothers aged 20-24, 16-19 and 12-15 years were at an increased risk of mortality (adjusted odds ratio [OR] 1.24, 95% confidence interval [CI] 1.17, 1.30; OR 1.81, 95% CI 1.71, 1.93; OR 2.29, 95% CI 1.96, 2.67, respectively). Neonates born to mothers aged 30-34, 35-39, 40-44, and ≥45 years were also at an increased risk of mortality (OR 1.09, 95% CI 1.03, 1.15; OR 1.30, 95% CI 1.21, 1.39; OR 1.50, 95% CI 1.38, 1.64; OR 1.84, 95% CI 1.54, 2.20, respectively). The results were consistent across most subgroup analyses.

CONCLUSIONS

Neonates born to younger (<25 years) and older mothers (≥30 years) are at increased risk of neonatal death in LMICs.

Social class inequalities in perinatal outcomes: Scotland 1980-2000

OBJECTIVE

To examine social class inequalities in adverse perinatal events in Scotland between 1980 and 2000 and how these were influenced by other maternal risk factors.

DESIGN

Population based study using routine maternity discharge data.

SETTING

Scotland.

PARTICIPANTS

All women who gave birth to a live singleton baby in Scottish hospitals between 1980 and 2000 (n=1,282,172).

MAIN OUTCOME MEASURES

Low birth weight (LBW), preterm birth, and small for gestational age (SGA).

RESULTS

The distribution of social class changed over time, with the proportion of mothers with undetermined social class increasing from 3.9% in 1980-84 to 14.8% in 1995-2000. The relative index of inequality (RII) decreased during the 1980s for all outcomes. The RII then increased between the early and late 1990s (LBW from 2.09 (95%CI 1.97, 2.22) to 2.43 (2.29, 2.58), preterm from 1.52 (1.44, 1.61) to 1.75 (1.65, 1.86), and SGA from 2.28 (2.14, 2.42) to 2.49 (2.34, 2.66) respectively). Inequalities were greatest in married mothers, mothers aged over 35, mothers taller than 164 cm, and mothers with a parity of one or more. Inequalities were also greater by the end of the 1990s than at the start of the 1980s for women of parity one or more and for mothers who were not married.

CONCLUSION

Despite decreasing during the 1980s, inequalities in adverse perinatal outcomes increased during the 1990s in all strata defined by maternal characteristics.

Searching for socioeconomic risk factors in perinatal mortality in Kuwait: a case control study

The aim of this paper was to investigate whether socioeconomic factors such as parent's education, occupation, and income constitute risk factors in perinatal mortality after controlling for biological variables such as birth weight and length of gestation, and maternal factors such as age, parity and reproductive history. A case-control study covering all perinatal deaths in Kuwait was conducted for one year from 1 October, 1997 to 30 September, 1998. Each case (perinatal death) was matched with a control (live birth). Matching criteria were: father's nationality, place, and date of birth. Information was successfully collected on 463 matched pairs, 274 Kuwaitis and 189 non-Kuwaitis. Only singleton births were included in the analysis. Bivariate analysis showed that several of the socioeconomic variables (e.g. lower education, lower income) increased the risk of a perinatal death. However, none of these variables remained significant in the multivariate analysis in which birth weight and length of gestation emerged as the two major determinants of perinatal deaths among both nationality groups. Among the Kuwaitis, primiparity and high parity, and previous history of miscarriage were also significant risk factors. Among the non-Kuwaitis, none of the socioeconomic factors, or the maternal factors, were significant predictors of perinatal mortality. For Kuwaitis, it appears that the government's policies and programs aimed at reducing social inequalities in the society have been effective in eliminating perinatal mortality differences between socioeconomic groups. Among non-Kuwaitis, the lack of differences is reflective of the fact that this group is relatively homogenous and selective of the more affluent who can bring the family to Kuwait. Both nationality groups benefit from the government's free health services. However, charges for non-Kuwaitis are due to be levied soon which may increase disparities in access to health care.

Trends in perinatal death rates in Denmark and Sweden, 1915-1990

Perinatal mortality rate (PMR) is often taken as an indicator of the quality of obstetric care. Its decline started in the early 1940s in Denmark and Sweden, at the same time as in several other European countries, and its development has been strikingly parallel in the two Scandinavian countries. The changes in the mothers' ages and birth order do not coincide with the changes in the PMR. The percentage of children born weighing less than 2500 g has been very stable over time, albeit higher in Denmark. The move towards hospital confinements in obstetric care took place mainly in the 1930s in Sweden, i.e. before the decline started, and in the 1950s and 1960s in Denmark. The factors investigated have contributed very little to explain why the PMR started to decline in the early 1940s. Factors associated with the distribution of perinatal deaths in a population do not seem to be able to explain the changes taking place over time. In the current study it is postulated that factors behind the change in the PMR are improvements in the mothers' health together with the decline in the total period fertility rate from the beginning of this century. With a smaller number of children the risk of infection was reduced and the amount of food available to each child and pregnant woman increased. This better health in early life may be associated with improved reproductive health in the adult years.

The effects of family position and status on health

In the last couple of decades there has been a considerable amount of research, mainly in the U.S.A., on the effects of family position on health. This paper reviews material on (a) the impact of family of origin on health and (b) adult family position and health. Parental divorce is shown to be related to a range of adverse outcomes in childhood, adolescence and adulthood. Marriage and parenthood are associated with longevity and good mental and physical health. This paper argues for more research in other cultural settings, for panel studies, for more direct measures of the roles and processes often inferred from structural variables, and for the use of measures of physical development and functioning.

The relationship between sociodemographic variables and pregnancy loss in a rural area of Bangladesh

This study examines the relationship between eight sociodemographic variables and the risk of pregnancy loss in a rural area of Bangladesh. The risks of spontaneous miscarriage and stillbirth were significantly associated with maternal age, pregnancy order and previous pregnancy wastage.

Econometric studies in health economics. A survey of the British literature

This paper provides a survey of British applied econometric work in the field of health economics. As well as reviewing the literature, it suggests some avenues for future research. It covers six main areas: the supply of health care; the demand for health care; non-medical influences on health; market and non-price rationing; evaluation of health care systems; and planning, budgeting and monitoring mechanisms.

Parity specific perinatal mortality. A longitudinal study based on sibships

Perinatal mortality in sibships has been examined using the Medical Birth Registry of Norway. Using linear logistic regression, parity specific perinatal mortality in the period 1967-1981 has been analysed, controlling simultaneously for maternal age, year of birth and survival of earlier births. The risk of a perinatal loss was increased by a factor of up to 6.0 following one earlier perinatal loss, and with three earlier losses the increase was 17.0. The general reduction in mortality between the different five year periods varied according to parity and maternal age. No secular reduction in risk, however, was demonstrated in sibships where the first birth died perinatally; for some subgroups of women the risk actually increased between the first and the second five year period. The effect of maternal age changed with parity, being strong in the first birth order, but of no effect either for the third or the fourth birth orders once the perinatal survival of earlier births was controlled for. This study shows the need to take heterogeneity of risk between women into account in studies of perinatal loss; the overall improvement in perinatal mortality does not apply to every woman. As care improves, perinatal losses become less and less random, demonstrated by increased risks of recurrence.

Core-periphery differences in infant mortality

The study aims to describe the development of core-periphery differences in infant mortality trends in Finland from 1950 to 1984. The infant mortality trends in core and in periphery are described at three levels of spatial hierarchy: (1) nation, (2) province and (3) local hospital region. The main findings are: (1) at the national level: (a) the differences between core and periphery in infant mortality trends disappear by the mid 1960s, mainly due to the equalization of postneonatal mortality and (b) the diminishing of postneonatal mortality stops and the diminishing of especially the first-day mortality begins about the middle of 1960s, both in core and periphery; (2) in the province of Uundenmaan lääni there are no differences in infant mortality trends between the metropolitan area of Helsinki (core) and the rest of this province (periphery); (3) in the two local hospital regions the diminishing of infant mortality is significantly slower in periphery than in core. At present there is scarcely any core-periphery variation in the trends of different components of infant mortality. This is a very remarkable fact when the achievements of the health and social policy of Finland are assessed. Several possible methodological, socio-economic, demographic and health care factors that may explain the differences in infant mortality trends between core and periphery at different levels of spatial hierarchy are discussed.