The Impact of Neighbourhood Deprivation on Embryonic Growth Trajectories: Rotterdam Periconception Cohort

Living in a low socioeconomic status neighbourhood is associated with lower cumulative ongoing pregnancy rate after IVF treatment

RESEARCH QUESTION

Does an association exist between neighbourhood socioeconomic status (SES) and the cumulative rate of ongoing pregnancies after 2.5 years of IVF treatment?

DESIGN

A retrospective observational study involving 2669 couples who underwent IVF or IVF and intracytoplasmic sperm injection treatment between 2006 and 2020. Neighbourhood SES for each couple was determined based on their residential postal code. Subsequently, SES was categorized into low (p80). Multivariable binary logistic regression analyses were conducted, with the cumulative ongoing pregnancy within 2.5 years as the outcome variable. The SES category (reference category: high), female age (reference category: 32-36 years), body mass index (reference category: 23-25 kg/m2), smoking status (yes/no), number of oocytes after the first ovarian stimulation, embryos usable for transfer or cryopreservation after the first cycle, duration of subfertility before treatment and insemination type were used as covariates.

RESULTS

A variation in ongoing pregnancy rates was observed among SES groups after the first fresh embryo transfer. No difference was found in the median number of IVF treatment cycles carried out. The cumulative ongoing pregnancy rates differed significantly between SES groups (low: 44%; medium: 51%; high: 56%; P < 0.001). Low neighbourhood SES was associated with significantly lower odds for achieving an ongoing pregnancy within 2.5 years (OR 0.66, 95% CI 0.52 to 0.84, P < 0.001).

CONCLUSION

Low neighbourhood SES compared with high neighbourhood SES is associated with reducing odds of achieving an ongoing pregnancy within 2.5 years of IVF treatment.

An Evaluation of Food and Nutrient Intake among Pregnant Women in The Netherlands: A Systematic Review

Nutritional deficiencies during pregnancy can have serious consequences for the health of the (unborn) child. This systematic review provides an updated overview of the available food and nutrient intake data for pregnant women in The Netherlands and an evaluation based on the current recommendations. Embase, MEDLINE, and national institute databases were used. Articles were selected if they had been published since 2008 and contained data on food consumption, nutrient intake, or the status of healthy pregnant women. A qualitative comparison was made with the 2021 Dutch Health Council recommendations and reference values. A total of 218 reports were included, representing 54 individual studies. Dietary assessments were primarily performed via food frequency questionnaires. Protein, vitamin A, thiamin, riboflavin, vitamin B₆, folate, vitamin B₁₂, vitamin C, iron, calcium, and magnesium intakes seemed to be adequate. For folate and vitamin D, supplements were needed to reach the recommended intake. The reasons for concern are the low intakes of fruits, vegetables, and (fatty) fish, and the intakes of alcohol, sugary drinks, and salt. For several foods and nutrients, no or limited intake data were found. High-quality, representative, and recent data are needed to evaluate the nutrient intake of pregnant women in order to make accurate assessments and evaluations, supporting scientific-based advice and national nutritional policies.

Complexity and interplay of faced adversities and perceived health and well-being in highly vulnerable pregnant women-the Mothers of Rotterdam program

BACKGROUND

Living in socially disadvantaged circumstances has a widespread impact on one's physical and mental health. That is why individuals living in this situation are often considered vulnerable. When pregnant, not only the woman's health is affected, but also that of her (unborn) child. It is well accepted that vulnerable populations experience worse (perinatal) health, however, little is known about the lived adversities and health of these vulnerable individuals.

OBJECTIVES

With this article, insights into this group of highly vulnerable pregnant women are provided by describing the adversities these women face and their experienced well-being.

METHODS

Highly vulnerable women were recruited when referred to tailored social care during pregnancy. Being highly vulnerable was defined as facing at least three different adversities divided over two or more life-domains. The heat map method was used to assess the interplay between adversities from the different life domains. Demographics and results from the baseline questionnaires on self-sufficiency and perceived health and well-being were presented.

RESULTS

Nine hundred nineteen pregnant women were referred to social care (2016-2020). Overall, women had a median of six adversities, distributed over four life-domains. The heat map revealed a large variety in lived adversities, which originated from two parental clusters, one dominated by financial adversities and the other by a the combination of a broad range of adversities. The perceived health was moderate, and 25-34% experienced moderate to severe levels of depression, anxiety or stress. This did not differ between the two parental clusters.

CONCLUSIONS

This study shows that highly vulnerable pregnant women deal with multiple adversities affecting not only their social and economic position but also their health and well-being.

Exposure to outdoor residential noise during pregnancy, embryonic size, fetal growth, and birth outcomes

INTRODUCTION

Previous literature suggested that noise exposure during pregnancy was not associated with adverse birth outcomes. However, no studies evaluated the association between noise exposure and embryonic and fetal growth, or mutually assessed other urban environmental exposures such as traffic-related air pollution or natural spaces.

METHODS

We included 7947 pregnant women from the Generation R Study, the Netherlands. We estimated total (road traffic, aircraft, railway, and industry), road traffic, and railway noise at the participants' home addresses during pregnancy using environmental noise maps. We estimated traffic-related air pollution using land-use regression models, greenness within a 300 m buffer using the normalized difference vegetation index, and distance to blue spaces using topographical maps at the home addresses. Embryonic size (crown-rump length) and fetal growth parameters (head circumference, femur length, and estimated fetal weight) were measured by ultrasound at several gestational ages. Information on neonatal anthropometrics at birth (head circumference, length, and weight) and adverse birth outcomes (preterm birth, low birth weight, and small for gestational age) were retrieved from medical records.

RESULTS

Higher total noise exposure during pregnancy was associated with larger crown-rump length (0.07 SDS [95%CI 0.00 to 0.14]). No association was found with fetal growth parameters, neonatal anthropometrics, and adverse birth outcomes. Similar results were observed for road traffic noise exposure, while railway noise exposure was not associated with any of the outcomes. Traffic-related air pollution was not associated with crown-rump length. Total noise exposure mediated 15% of the association between exposure to greenness and smaller crown-rump length. No association was observed between distance to blue spaces and total noise exposure.

CONCLUSION

Exposure to outdoor residential noise during pregnancy was associated with larger embryonic size. Moreover, a reduction of total noise exposure during pregnancy partially mediated the association between exposure to greenness and smaller embryonic size. Additional research is warranted to confirm and further understand these novel findings.

Association between neighbourhood deprivation, fetal growth, small-for-gestational age and preterm birth: a population-based prospective cohort study

OBJECTIVE

To study the associations between neighbourhood deprivation and fetal growth, including growth in the first trimester, and adverse pregnancy outcomes.

DESIGN

Prospective cohort study.

SETTING

The Netherlands, Rotterdam.

PARTICIPANTS

8617 live singleton births from the Generation R cohort study.

EXPOSITION

Living in a deprived neighbourhood.

MAIN OUTCOME MEASURES

Fetal growth trajectories of head circumference, weight and length.

SECONDARY OUTCOMES MEASURES

Small-for-gestational age (SGA) and preterm birth (PTB).

RESULTS

Neighbourhood deprivation was not associated with first trimester growth. However, a higher neighbourhood status score (less deprivation) was associated with increased fetal growth in the second and third trimesters (eg, estimated fetal weight; adjusted regression coefficient 0.04, 95% CI 0.02 to 0.06). Less deprivation was also associated with decreased odds of SGA (adjusted OR 0.91, 95% CI 0.86 to 0.97, p=0.01) and PTB (adjusted OR 0.89, 95% CI 0.82 to 0.96, p=0.01).

CONCLUSIONS

We found an association between neighbourhood deprivation and fetal growth in the second and third trimester pregnancy, but not with first trimester growth. Less neighbourhood deprivation is associated with lower odds of adverse pregnancy outcomes. The associations remained after adjustment for individual-level risk factors. This supports the hypothesis that living in a deprived neighbourhood acts as an independent risk factor for fetal growth and adverse pregnancy outcomes, above and beyond individual risk factors.