Center for Environmental and Respiratory Health Research, Faculty of Medicine, University of Oulu, Oulu, Finland.
PLoS One. 2013 Jul 22;8(7):e69181. doi: 10.1371/journal.pone.0069181. Print 2013.
The epidemiological evidence linking socioeconomic deprivation with adverse pregnancy outcomes has been conflicting mainly due to poor measurement of socioeconomic status (SES). Studies have also failed to evaluate the plausible pathways through which socioeconomic disadvantage impacts on pregnancy outcomes. We investigated the importance of maternal SES as determinant of birth weight and gestational duration in an urban area and evaluated main causal pathways for the influence of SES.
A population-based cross-sectional study was conducted among 559 mothers accessing postnatal services at the four main health facilities in Cape Coast, Ghana in 2011. Information on socioeconomic characteristics of the mothers was collected in a structured questionnaire.
In multivariate linear regression adjusting for maternal age, parity and gender of newborn, low SES resulted in 292 g (95% CI: 440-145) reduction in birth weight. Important SES-related determinants were neighborhood poverty (221 g; 95% CI: 355-87), low education (187 g; 95% CI: 355-20), studentship during pregnancy (291 g; 95% CI: 506-76) and low income (147 g; 95% CI: 277-17). In causal pathway analysis, malaria infection (6-20%), poor nutrition (2-51%) and indoor air pollution (10-62%) mediated substantial proportions of the observed effects of socioeconomic deprivation on birth weight. Generalized linear models adjusting for confounders indicated a 218% (RR: 3.18; 95% CI: 1.41-7.21) risk increase of LBW and 83% (RR: 1.83; 95% CI: 1.31-2.56) of PTB among low income mothers. Low and middle SES was associated with 357% (RR: 4.57; 95% CI: 1.67-12.49) and 278% (RR: 3.78; 95% CI: 1.39-10.27) increased risk of LBW respectively. Malaria infection, poor nutrition and indoor air pollution respectively mediated 10-21%, 16-44% and 31-52% of the observed effects of socioeconomic disadvantage on LBW risk.
We provide evidence of the effects of socioeconomic deprivation, substantially mediated by malaria infection, poor nutrition and indoor air pollution, on pregnancy outcomes in a developing country setting.
由于社会经济地位（SES）的测量不佳，将社会经济剥夺与不良妊娠结局联系起来的流行病学证据一直存在冲突。研究也未能评估社会经济劣势影响妊娠结局的可能途径。我们在加纳海岸角的四个主要卫生机构接受产后服务的 559 位母亲中进行了一项基于人群的横断面研究，以调查母亲 SES 作为出生体重和妊娠持续时间决定因素的重要性，并评估 SES 影响的主要因果途径。
在 2011 年，我们对加纳海岸角的四个主要卫生机构中接受产后服务的 559 位母亲进行了一项基于人群的横断面研究，以评估母亲 SES 作为出生体重和妊娠持续时间决定因素的重要性，并评估 SES 影响的主要因果途径。在结构问卷中收集了母亲社会经济特征的信息。
在调整母亲年龄、产次和新生儿性别等因素的多元线性回归中，低 SES 导致出生体重降低 292 克（95%CI：440-145）。与 SES 相关的重要决定因素包括社区贫困（221 克；95%CI：355-87）、低教育水平（187 克；95%CI：355-20）、孕期学生身份（291 克；95%CI：506-76）和低收入（147 克；95%CI：277-17）。在因果途径分析中，疟疾感染（6-20%）、营养不良（2-51%）和室内空气污染（10-62%）对社会经济剥夺对出生体重的影响有很大的影响。调整混杂因素的广义线性模型表明，低收入母亲的低出生体重（LBW）风险增加 218%（RR：3.18；95%CI：1.41-7.21），早产（PTB）风险增加 83%（RR：1.83；95%CI：1.31-2.56）。低和中等 SES 与 LBW 的风险增加分别相关 357%（RR：4.57；95%CI：1.67-12.49）和 278%（RR：3.78；95%CI：1.39-10.27）。疟疾感染、营养不良和室内空气污染分别介导了社会经济劣势对 LBW 风险影响的 10-21%、16-44%和 31-52%。
我们提供了证据表明，在发展中国家环境中，社会经济剥夺通过疟疾感染、营养不良和室内空气污染等因素，对妊娠结局产生了影响。
