A large proportion of poor birth outcomes among Aboriginal Western Australians are attributable to smoking, alcohol and substance misuse, and assault

Alison J Gibberd,Fiona Stanley,Judy M Simpson,Sandra J Eades,Jocelyn Jones,Robyn Williams

doi:10.1186/s12884-019-2252-4

Abstract

BackgroundAboriginal infants have poorer birth outcomes than non-Aboriginal infants. Harmful use of tobacco, alcohol, and other substances is higher among Aboriginal women, as is violence, due to factors such as intergenerational trauma and poverty. We estimated the proportion of small for gestational age (SGA) births, preterm births, and perinatal deaths that could be attributed to these risks.MethodsBirth, hospital, mental health, and death records for Aboriginal singleton infants born in Western Australia from 1998 to 2010 and their parents were linked. Using logistic regression with a generalized estimating equation approach, associations with birth outcomes and population attributable fractions were estimated after adjusting for demographic factors and maternal health during pregnancy.ResultsOf 28,119 births, 16% of infants were SGA, 13% were preterm, and 2% died perinatally. 51% of infants were exposed in utero to at least one of the risk factors and the fractions attributable to them were 37% (SGA), 16% (preterm) and 20% (perinatal death).ConclusionsA large proportion of adverse outcomes were attributable to the modifiable risk factors of substance use and assault. Significant improvements in Aboriginal perinatal health are likely to follow reductions in these risk factors. These results highlight the importance of identifying and implementing risk reduction measures which are effective in, and supported by, Aboriginal women, families, and communities.

Highlights

Aboriginal infants have poorer birth outcomes than non-Aboriginal infants
Harmful use of alcohol and drugs, and assault against the mother are all associated with poor birth outcomes [4, 5] and are more common among Aboriginal than non-Aboriginal women
Alcohol was associated with 118% higher odds of small for gestational age (SGA) and 83% high odds of perinatal death, but the association with preterm birth, while positive, was not statistically significant

Summary

Introduction

Alcohol, and other substances is higher among Aboriginal women, as is violence, due to factors such as intergenerational trauma and poverty. In the state of Western Australia (WA), preterm birth, stillbirth, and neonatal death rates are 2–3 times higher and the average birthweight is 200 g less for infants with Aboriginal mothers than non-Aboriginal mothers [1, 2]. In the past three decades, though the neonatal death rate has Smoking during pregnancy, harmful use of alcohol and drugs, and assault against the mother are all associated with poor birth outcomes [4, 5] and are more common among Aboriginal than non-Aboriginal women. The use of tobacco, alcohol and drugs, and assault are inter-related and multiple risk factors can aggregate in pregnancy [11]

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Discussion

Conclusion