Cantarutti Anna, Franchi Matteo, Monzio Compagnoni Matteo, Merlino Luca, Corrao Giovanni
Department of Statistics and Quantitative Methods, Division of Biostatistics, Epidemiology and Public Health, Laboratory of Healthcare Research and Pharmacoepidemiology, University of Milano-Bicocca, Via Bicocca degli Arcimboldi 8, U7, 20126, Milan, Italy.
Operative Unit of Territorial Health Services, Region Lombardia, Milan, Italy.
BMC Pregnancy Childbirth. 2017 Jul 12;17(1):221. doi: 10.1186/s12884-017-1418-1.
Maternal socioeconomic disparities strongly affect child health, particularly in low and middle income countries. We assessed whether neonatal outcomes varied by maternal education in a setting where healthcare system provides universal coverage of health services to all women, irrespective of their socioeconomic status.
A population-based study was performed on 383,103 singleton live births occurring from 2005 to 2010 in Lombardy, an Italian region with approximately 10 million inhabitants. The association between maternal education, birthplace and selected neonatal outcomes (preterm birth, low birth weight, small-for-gestational age, low 5-min Apgar score, severe congenital anomalies, cerebral distress and respiratory distress) was estimated by fitting logistic regression models. Model adjustments were applied for sociodemographic, reproductive and medical maternal traits.
Compared with low-level educated mothers, those with high education had reduced odds of preterm birth (Odds Ratio; OR = 0.81, 95% CI 0.77-0.85), low birth weight (OR = 0.78, 95% CI 0.70-0.81), small for gestational age (OR = 0.82, 95% CI 0.79-0.85), and respiratory distress (OR = 0.84, 95% CI 0.80-0.88). Mothers born in a foreign country had higher odds of preterm birth (OR = 1.16, 95% CI 1.11-1.20), low Apgar score (OR = 1.18, 95% CI 1.07-1.30) and respiratory distress (OR = 1.19, 95% CI 1.15-1.24) than Italian-born mothers. The influence of maternal education on neonatal outcomes was confirmed among both, Italian-born and foreign-born mothers.
Low levels of education and maternal birthplace are important factors associated with adverse neonatal outcomes in Italy. Future studies are encouraged to investigate factors mediating the effects of socioeconomic inequality for identifying the main target groups for interventions.
孕产妇的社会经济差异对儿童健康有很大影响，在低收入和中等收入国家尤其如此。我们评估了在一个医疗系统为所有妇女提供普遍医疗服务覆盖的地区，无论其社会经济地位如何，新生儿结局是否因母亲教育程度而异。
对2005年至2010年在伦巴第发生的383,103例单胎活产进行了一项基于人群的研究。伦巴第是意大利的一个地区，约有1000万居民。通过拟合逻辑回归模型，估计母亲教育程度、出生地与选定的新生儿结局（早产、低出生体重、小于胎龄儿、5分钟阿氏评分低、严重先天性异常、脑窘迫和呼吸窘迫）之间的关联。对社会人口学、生殖和母亲医学特征进行了模型调整。
与低学历母亲相比，高学历母亲早产（优势比；OR = 0.81，95%CI 0.77 - 0.85）、低出生体重（OR = 0.78，95%CI 0.70 - 0.81）、小于胎龄儿（OR = 0.82，95%CI 0.79 - 0.85）和呼吸窘迫（OR = 0.84，95%CI 0.80 - 0.88）的几率降低。在国外出生的母亲比在意大利出生的母亲早产（OR = 1.16，95%CI 1.11 - 1.20）、阿氏评分低（OR = 1.18，95%CI 1.07 - 1.30）和呼吸窘迫（OR = 1.19，95%CI 1.15 - 1.24）的几率更高。母亲教育程度对新生儿结局的影响在意大利出生和国外出生的母亲中均得到证实。
在意大利，低教育水平和母亲出生地是与不良新生儿结局相关的重要因素。鼓励未来的研究调查介导社会经济不平等影响的因素，以确定干预的主要目标群体。
