Partnership, living arrangements, and low birth weight: evidence from a population-based study on Spanish mothers

BACKGROUND

Birth weight is considered a crucial indicator of individual and population health, as it determines a newborn's growth and development. An extensive body of research has explored various determinants of perinatal health, including the impact of living arrangements. This population-based study analyzes the relationship between mothers' partnership status and household structure and children's low birth weights. It addresses two basic research objectives: on one hand, how living/not living in a couple affects birth weight; on the other, how partnership status impact on birthweight when mothers live in extended households with other non-nuclear members.

METHODS

A novel database provided by the Spanish Office for National Statistics (INE), which links the 2011 census with births registered from 2011 to 2015 (sample size 22,433) is used. Llogistic regression models are estimated tto obtain adjusted odds ratios (OR) for the relative effects of living arrangements and other covariates such as characteristics of births and mothers' socioeconomic profiles, on birth weight.

RESULTS

Differences in low-birth-weight rates may be attributed to the dissimilar socio-demographic characteristics of the groups of mothers in the different coresidential situations. Although our models revealed that the impact of the covariates on birth weight was similar to that shown by previous studies, this was not the case for the effect of the main explanatory variable. Contrary to expectations, the presence/absence of a male partner in nuclear or in extended households does not reveal significant protection against low birth weight. Children born in households in which the male partner was absent were not more likely to have a low birth weight. On the other hand, analyzing the possible protective effect of extended households, we did not detect significant differences in the likelihood of low birth weight between single mothers without and with non-nuclear coresidents in their households.

CONCLUSIONS

Our analysis provides novel evidence regarding the effect of partnership status and household type on perinatal health in Spain. First, contrary to what has been observed in previous studies in Spain and elsewhere, our study shows that living without a partner has no effect on low birth weight. Second, we reveal that households including non-nuclear coresidents are associated with low birth weight suggesting that even in a basically familist societal context such as the Spanish one, the extended family does not fully protect against poor perinatal outcomes.

Relationship between historical developments in the percentages of low birthweight and fetal mortality in Spain

OBJECTIVE

To document the differences in low birthweight in different population subgroups and to analyze its possible relationship with fetal mortality rates in Spain.

METHOD

We used the microdata on live births and stillbirths since 1975 to 2020 from the Spanish National Statistics Institute to examine differentials in delivering a low birthweight controlling for different sociodemographic variables and to determine the relationship between low birthweight and fetal mortality. No statistical analysis was necessary beyond the calculation of percentages and rates.

RESULTS

The data at our disposal for Spain confirm the historical increase in the incidence of low birthweight and allow us to link trends in low birthweight with a decrease in the fetal mortality rate. When fetal mortality is high, the incidence of low birthweight is low, given that a natural selection effect takes place.

CONCLUSIONS

The surprising historical increase in the incidence of low birthweight in Spain can be explained by the improvement in mortality rates. As more fetuses of lower gestational age are born alive, cases of low birthweight also increase.

Nutritional Health Education in Pregnant Women in a Rural Health Centre: Results in Spanish and Foreign Women

The dietary behaviour of pregnant women, as well as the socio-cultural conditions in which pregnancy takes place, influence obstetric outcomes. To analyse the influence of socioeconomic factors and dietary habits on obstetric outcomes in Spanish and foreign pregnant women living in a rural environment, a population-based, prospective-observational study in a cohort of Spanish and foreign pregnant women in the town of Yepes, in the province of Toledo, Spain was conducted. Foreign pregnant women are ecodependent on their partners, have secondary education and low socioeconomic level. Spanish pregnant women have secondary education, a medium socio-economic level, live with their partners and are economically independent. Moreover, 85% of Spanish pregnant women gave birth at term and reached a gestational age of 40 ± 1.83 weeks. However, only 55% of foreign pregnant women reached a gestational age of 39.72 ± 2.28 weeks. Through health education, pregnant women in this geographical area of Castilla la Mancha, Spain, adopted bicultural dietary patterns, thus reaching the prescribed diet of 2000 Kcal. Through this diet, both Spanish and foreign pregnant women maintained albumin and plasma protein levels within the established range, with no significant differences in obstetric outcomes among pregnant women in the study.

Prevalence of Hypoproteinemia and Hypoalbuminemia in Pregnant Women from Three Different Socioeconomic Populations

Protein requirements of pregnant women are increased due to anatomical and physiological changes. However, optimal levels of plasma proteins do not receive adequate attention from health professionals and researchers. We aimed to evaluate the plasma protein status in pregnant women receiving care at health centers, with the intention of identifying potential deficiency states and their relationship with quality of life during pregnancy. This is a population-based, prospective, and observational study among a cohort of 215 pregnant women from three different socioeconomic areas (urban, semi-urban, and rural). Blood samples in the first (T1), second (T2), and third (T3) trimester of pregnancy were obtained to quantify the proteins and albumin levels. Statically significant differences regarding the age of pregnant women (p = 0.002), education status (p = 0.034), and socioeconomic level (p = 0.000), were found among groups. Prevalence of protein and albumin deficits was much higher in women from rural and semi-urban areas than in women from urban areas (p = 0.001). Moreover, these deficits were associated with the appearance of edema. Plasma total protein deficit could be an undervalued public health problem in pregnant women receiving prenatal care that could affect the quality of life in the gestational period. It would be important to establish reference intervals for plasma protein monitoring in each trimester of pregnancy, and protein levels should be measured routinely throughout pregnancy.

Is the economic crisis affecting birth outcome in Spain? Evaluation of temporal trend in underweight at birth (2003-2012)

BACKGROUND

There is growing evidence of the impact of the current European economic crisis on health. In Spain, since 2008, there have been increasing levels of impoverishment and inequality, and important cuts in social services.

AIM

The objective is to evaluate the impact of the economic crisis on underweight at birth in Spain.

METHOD

Trends in underweight at birth were examined between 2003 and 2012. Underweight at birth is defined as a singleton, term neonatal weight lesser than -2 SD from the median weight at birth for each sex estimated by the WHO Standard Growth Reference. Using data from the Statistical Bulletin of Childbirth, 2 933 485 live births born to Spanish mothers have been analysed. Descriptive analysis, seasonal decomposition analysis and crude and adjusted logistic regression including individual maternal and foetal variables as well as exogenous economic indicators have been performed.

RESULTS AND CONCLUSIONS

Results demonstrate a significant increase in the prevalence of underweight at birth from 2008. All maternal-foetal categories were affected, including those showing the lowest prevalence before the crisis. In the full adjusted logistic regression, year-on-year GDP per capita remains predictive on underweight at birth risk. Previous trends in maternal socio-demographic profiles and a direct impact of the crisis are discussed to explain the trends described.

Race, Socioeconomic Status, and Age: Exploring Intersections in Preterm Birth Disparities among Teen Mothers

Few studies have examined disparities in adverse birth outcomes and compared contributing socioeconomic factors specifically between African-American and White teen mothers. This study examined intersections between neighborhood socioeconomic status (as defined by census-tract median household income), maternal age, and racial disparities in preterm birth (PTB) outcomes between African-American and White teen mothers in North Carolina. Using a linked dataset with state birth record data and socioeconomic information from the 2010 US Census, disparities in preterm birth outcomes for 16,472 teen mothers were examined through bivariate and multilevel analyses. African-American teens had significantly greater odds of PTB outcomes than White teens (OR = 1.38, 95% CI 1.21, 1.56). Racial disparities in PTB rates significantly varied by neighborhood income; PTB rates were 2.1 times higher for African-American teens in higher income neighborhoods compared to White teens in similar neighborhoods. Disparities in PTB did not vary significantly between teens younger than age 17 and teens ages 17-19, although the magnitude of racial disparities was larger between younger African-American and White teens. These results justify further investigations using intersectional frameworks to test the effects of racial status, neighborhood socioeconomic factors, and maternal age on birth outcome disparities among infants born to teen mothers.