Torres-Torres Johnatan, Martinez-Portilla Raigam, Espino-Y-Sosa Salvador, Monroy-Muñoz Irma Eloisa, Perez-Duran Javier, Solis-Paredes Juan Mario, Olivares Hector Borboa, Cerda-Flores Pablo, Rojas-Zepeda Lourdes, Estrada-Gutierrez Guadalupe
Department of Reproductive and Perinatal Health Research, Instituto Nacional de Perinatología "Isidro Espinosa de los Reyes", Mexico City, México.
Obstetric and Gynecology Department, Hospital General de México "Dr. Eduardo Liceaga", Mexico City, México.
Int J Equity Health. 2025 Apr 17;24(1):105. doi: 10.1186/s12939-025-02471-w.
Perinatal mortality, encompassing late stillbirths and neonatal mortalities, is a key indicator of maternal and neonatal health. Despite advances in health care, there have been alarming increased in perinatal mortality rates in Mexico. This study investigated the influence of social determinants on perinatal death in a Latin American middle-income country, aiming to inform equitable and effective health policies.
A prospective cohort study was conducted with pregnant women from Mexico City. Data on the following clinical and social factors were collected: pregestational body mass index (pBMI), lupus, antiphospholipid syndrome (APS), preeclampsia, foetal growth restriction (FGR), social vulnerability, poverty, household overcrowding, and gender-based violence. Nested logistic regression models were developed to identify significant predictors of perinatal mortality, with the results reported as odds ratios (ORs) and 95% confidence intervals (CIs).
Among the 3,890 participants, there were 76 cases of perinatal mortality. Significant clinical predictors of perinatal mortality included higher pBMI (OR = 1.088, 95% CI 1.026-1.153), APS (OR = 10.049, 95% CI 1.843-54.803), and FGR (OR = 2.929, 95% CI 1.399-6.135), whereas high social vulnerability (OR = 5.332, 95% CI 2.485-11.443) and medium social vulnerability (OR = 3.084, 95% CI 1.528-6.222) emerged as significant social predictors of perinatal mortality. A comprehensive model incorporating both clinical and social determinants achieved an AUC of 0.921, with a detection rate of 67.1% and a false-positive rate of 10%, this indicating a significant improvement in perinatal mortality prediction. The inclusion of social determinants progressively enhanced predictive performance, underscoring their critical role in risk assessment.
Clinical and social determinants significantly influence perinatal mortality. Addressing social inequalities and integrating social determinants into perinatal care could improve maternal and neonatal health outcomes. However, limitations such as reliance on self-reported data, ecological-level indicators for social vulnerability, and potential constraints on generalizability should be considered. These findings emphasize the need for targeted health policies to reduce social vulnerabilities and enhance health care access in middle-income countries.
围产期死亡率，包括晚期死产和新生儿死亡，是孕产妇和新生儿健康的关键指标。尽管医疗保健有所进步，但墨西哥的围产期死亡率却惊人地上升。本研究调查了社会决定因素对拉丁美洲一个中等收入国家围产期死亡的影响，旨在为公平有效的卫生政策提供依据。
对来自墨西哥城的孕妇进行了一项前瞻性队列研究。收集了以下临床和社会因素的数据：孕前体重指数（pBMI）、狼疮、抗磷脂综合征（APS）、先兆子痫、胎儿生长受限（FGR）、社会脆弱性、贫困、家庭拥挤和基于性别的暴力。建立了嵌套逻辑回归模型以确定围产期死亡率的重要预测因素，结果以比值比（OR）和95%置信区间（CI）报告。
在3890名参与者中，有76例围产期死亡病例。围产期死亡的重要临床预测因素包括较高的pBMI（OR = 1.088，95% CI 1.026 - 1.153）、APS（OR = 10.049，95% CI 1.843 - 54.803）和FGR（OR = 2.929，95% CI 1.399 - 6.135），而高社会脆弱性（OR = 5.332，95% CI 2.485 - 11.443）和中等社会脆弱性（OR = 3.084，95% CI 1.528 - 6.222）成为围产期死亡的重要社会预测因素。一个综合了临床和社会决定因素的模型的曲线下面积（AUC）为0.921，检测率为67.1%，假阳性率为10%，这表明围产期死亡率预测有显著改善。纳入社会决定因素逐步提高了预测性能，突出了它们在风险评估中的关键作用。
临床和社会决定因素对围产期死亡率有显著影响。解决社会不平等问题并将社会决定因素纳入围产期护理可以改善孕产妇和新生儿的健康结果。然而，应考虑一些局限性，如依赖自我报告数据、社会脆弱性的生态层面指标以及普遍性的潜在限制。这些发现强调了在中等收入国家制定有针对性的卫生政策以减少社会脆弱性和增加医疗保健可及性的必要性。
