Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK.
Primary Care Division, Public Health Wales, Cardiff, UK.
BMJ Open. 2021 Mar 15;11(3):e042753. doi: 10.1136/bmjopen-2020-042753.
There has been an unprecedented rise in infant mortality associated with deprivation in recent years in the United Kingdom (UK) and Republic of Ireland. A healthy pregnancy can have significant impacts on the life chances of children. The objective of this review was to understand the association between individual-level and household-level measures of socioeconomic status and adverse pregnancy outcomes.
Systematic review and meta-analysis.
Nine databases were searched (Medline, Embase, Scopus, ASSIA, CINAHL, PsycINFO, BNI, MIDRIS and Google Scholar) for articles published between 1999 and August 2019. Grey literature searches were also assessed.
Studies reporting associations between individual-level or household socioeconomic factors on pregnancy outcomes in the UK or Ireland.
Among the 82 353 search results, 53 821 titles were identified and 35 unique studies met the eligibility criteria. Outcomes reported were neonatal, perinatal and maternal mortality, preterm birth, birth weight and mode of delivery. Pooled effect sizes were calculated using random-effects meta-analysis. There were significantly increased odds of women from lower levels of occupation/social classes compared with the highest level having stillbirth (OR 1.40, 95% CI 1.23 to 1.59, I), neonatal mortality (OR 1.39, 95% CI 1.22 to 1.57, I), perinatal mortality (OR 1.39, 95% CI 1.23 to 1.57, I), preterm birth (OR 1.41, 95% CI 1.33 to 1.50, I) and low birth weight (OR 1.40, 95% CI 1.19 to 1.61, I). Limitations relate to available data, unmeasured confounders and the small number of studies for some outcomes.
This review identified consistent evidence that lower occupational status, especially manual occupations and unemployment, were significantly associated with increased risk of multiple adverse pregnancy outcomes. Strategies to improve pregnancy outcomes should incorporate approaches that address wider determinants of health to provide women and families with the best chances of having a healthy pregnancy and baby and to decrease pregnancy-related health inequalities in the general population.
PROSPERO CRD42019140893.
近年来，英国（UK）和爱尔兰共和国与贫困相关的婴儿死亡率空前上升。健康的怀孕对儿童的生活机会有重大影响。本综述的目的是了解个体和家庭社会经济地位指标与不良妊娠结局之间的关联。
系统评价和荟萃分析。
1999 年至 2019 年 8 月，在 9 个数据库（Medline、Embase、Scopus、ASSIA、CINAHL、PsycINFO、BNI、MIDRIS 和 Google Scholar）中搜索了文章。还评估了灰色文献检索。
报告英国或爱尔兰个体或家庭社会经济因素与妊娠结局之间关联的研究。
在 82353 条搜索结果中，确定了 53821 个标题，35 项独特的研究符合入选标准。报告的结果包括新生儿、围产期和产妇死亡率、早产、出生体重和分娩方式。使用随机效应荟萃分析计算了汇总效应量。与最高职业/社会阶层相比，来自较低职业/社会阶层的女性死产（OR 1.40，95%CI 1.23 至 1.59，I）、新生儿死亡率（OR 1.39，95%CI 1.22 至 1.57，I）、围产期死亡率（OR 1.39，95%CI 1.23 至 1.57，I）、早产（OR 1.41，95%CI 1.33 至 1.50，I）和低出生体重（OR 1.40，95%CI 1.19 至 1.61，I）的风险显著增加。限制因素涉及可用数据、未测量的混杂因素以及一些结局的研究数量较少。
本综述确定了一致的证据，即较低的职业地位，特别是体力劳动职业和失业，与多种不良妊娠结局的风险增加显著相关。改善妊娠结局的策略应纳入解决健康更广泛决定因素的方法，为妇女及其家庭提供拥有健康怀孕和婴儿的最佳机会，并减少一般人群中与怀孕相关的健康不平等。
PROSPERO CRD42019140893。
