Socioeconomic and ethnic inequalities are associated with greater risks for adverse pregnancy outcomes

1. Risk of stillbirth, preterm birth and fetal growth restriction was significantly greater in the most socioeconomically deprived group compared to the least deprived group.

2. Black and south Asian women experienced significantly worse pregnancy outcomes compared to White women.

Evidence Rating Level: 2 (Good) 

Study Rundown: Poor socioeconomic status (SES) and ethnic inequalities can substantially affect the course of pregnancy and underlying outcomes. Minimizing disparities has been suggested to be a key area of discussion to improve patient outcomes. This study aimed to determine the impact of SES and ethnicity on adverse pregnancy outcomes in England. The primary outcomes included stillbirth (death after 24 weeks of gestation), preterm birth (birth between 24- and 37-weeks of gestation), and fetal growth restriction (FGR; birth after 24 weeks of gestation and birthweight <3^rd centile for gestational age). According to study results, the risk of stillbirth, preterm birth and FGR was significantly greater in the most socioeconomically deprived group compared to the least deprived group, with a large proportion of each outcome being attributed to socioeconomic inequality. Furthermore, Black women were noted to be impacted the greatest, followed South Asian and White women. A major strength of this study was that it assessed multiple pregnancy outcomes stratified by race and included women from multiple sites in England.

Click to read the study in The Lancet

Relevant Reading: Association Between Socioeconomic Status and In Utero Fetal Brain Development

In-depth [retrospective cohort]: Between Apr 1, 2015, and Mar 31, 2017, 1,233,184 women were assessed for eligibility from 132 National Health Services hospitals in England. Included were uniparous mothers between 24 and 42 completed weeks of gestation. Excluded women (n=95,970) were those with multiparity, gestation <24 weeks, or no documented birth outcome.

1,155,981 women were included in the analysis. Of the live births, 6.0% (n=69,175) were preterm and 2.0% (n=22,679) were FGR. All three primary outcomes were significantly greater in the most socioeconomically deprived group compared to the least deprived group (0.5% vs. 0.3% for stillbirth, 7.2% vs. 4.9% for preterm birth, and 2.2% vs. 1.2% for FGR; p<0.0001 for all). Furthermore, 23.6% (95% confidence interval [CI] 16.7-29.8) of stillbirths, 18.5% (95% CI 16.9-20.2) of preterm births, and 31.1% (95% CI 28.3-33.8) of FGR births could be attributed to socioeconomic inequality according to population attributable fractions. Regarding ethnicity, Black and south Asian women were at a significantly greater disadvantage than White women (stillbirth: 0.7% Black vs. 0.3% White, preterm birth: 6.6% Black vs. 6.5% South Asian vs. 6.0% White, and FGR: 3.5% South Asian vs. 6.0% White; p<0.0001). Overall, findings from this study suggest that SES and ethnic inequalities result in significantly adverse pregnancy outcomes among British women.

Image: PD 

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