LIVE UMR 7362 CNRS (Laboratoire Image Ville Environnement), University of Strasbourg, 67100 Strasbourg, France.
Equipe PHARes Population Health Translational Research, Inserm CIC 1401, Bordeaux Population Health Research Center, University of Bordeaux, 33076 Boedeaux, France.
Int J Environ Res Public Health. 2022 Dec 10;19(24):16592. doi: 10.3390/ijerph192416592.
Scientific literature tends to support the idea that the pregnancy and health status of fetuses and newborns can be affected by maternal, parental, and contextual characteristics. In addition, a growing body of evidence reports that social determinants, measured at individual and/or aggregated level(s), play a crucial role in fetal and newborn health. Numerous studies have found social factors (including maternal age and education, marital status, pregnancy intention, and socioeconomic status) to be linked to poor birth outcomes. Several have also suggested that beyond individual and contextual social characteristics, living environment and conditions (or "neighborhood") emerge as important determinants in health inequalities, particularly for pregnant women. Using a comprehensive review, we present a conceptual framework based on the work of both the Commission on Social Determinants of Health and the World Health Organization (WHO), aimed at describing the various pathways through which social characteristics can affect both pregnancy and fetal health, with a focus on the structural social determinants (such as socioeconomic and political context) that influence social position, as well as on intermediary determinants. We also suggest that social position may influence more specific intermediary health determinants; individuals may, on the basis of their social position, experience differences in environmental exposure and vulnerability to health-compromising living conditions. Our model highlights the fact that adverse birth outcomes, which inevitably lead to health inequity, may, in turn, affect the individual social position. In order to address both the inequalities that begin in utero and the disparities observed at birth, it is important for interventions to target various unhealthy behaviors and psychosocial conditions in early pregnancy. Health policy must, then, support: midwifery availability and accessibility and enhanced multidisciplinary support for deprived pregnant women.
科学文献倾向于支持这样一种观点，即胎儿和新生儿的妊娠和健康状况可能受到母体、父母和环境特征的影响。此外，越来越多的证据表明，在个体和/或聚合层面上测量的社会决定因素在胎儿和新生儿健康中起着至关重要的作用。许多研究发现，社会因素（包括母亲的年龄和教育程度、婚姻状况、怀孕意愿和社会经济地位）与不良出生结局有关。一些研究还表明，除了个体和环境社会特征外，生活环境和条件（或“邻里”）作为健康不平等的重要决定因素出现，特别是对孕妇而言。我们使用综合综述，提出了一个基于卫生保健社会决定因素委员会和世界卫生组织（WHO）工作的概念框架，旨在描述社会特征影响妊娠和胎儿健康的各种途径，重点是影响社会地位的结构性社会决定因素（如社会经济和政治背景），以及中介决定因素。我们还认为，社会地位可能会影响更具体的中介健康决定因素；根据其社会地位，个人可能会在环境暴露和对健康有害的生活条件的脆弱性方面存在差异。我们的模型强调了这样一个事实，即不良的出生结局不可避免地导致健康不平等，反过来又可能影响个人的社会地位。为了解决胎儿期开始的不平等和出生时观察到的差异，干预措施必须针对早孕期间的各种不健康行为和心理社会状况。那么，卫生政策必须支持：助产士的可用性和可及性以及为贫困孕妇提供增强的多学科支持。
