Abstract
BackgroundThe epidemiological evidence linking socioeconomic deprivation with adverse pregnancy outcomes has been conflicting mainly due to poor measurement of socioeconomic status (SES). Studies have also failed to evaluate the plausible pathways through which socioeconomic disadvantage impacts on pregnancy outcomes. We investigated the importance of maternal SES as determinant of birth weight and gestational duration in an urban area and evaluated main causal pathways for the influence of SES.MethodsA population-based cross-sectional study was conducted among 559 mothers accessing postnatal services at the four main health facilities in Cape Coast, Ghana in 2011. Information on socioeconomic characteristics of the mothers was collected in a structured questionnaire.ResultsIn multivariate linear regression adjusting for maternal age, parity and gender of newborn, low SES resulted in 292 g (95% CI: 440–145) reduction in birth weight. Important SES-related determinants were neighborhood poverty (221 g; 95% CI: 355–87), low education (187 g; 95% CI: 355–20), studentship during pregnancy (291 g; 95% CI: 506–76) and low income (147 g; 95% CI: 277–17). In causal pathway analysis, malaria infection (6–20%), poor nutrition (2–51%) and indoor air pollution (10–62%) mediated substantial proportions of the observed effects of socioeconomic deprivation on birth weight. Generalized linear models adjusting for confounders indicated a 218% (RR: 3.18; 95% CI: 1.41–7.21) risk increase of LBW and 83% (RR: 1.83; 95% CI: 1.31–2.56) of PTB among low income mothers. Low and middle SES was associated with 357% (RR: 4.57; 95% CI: 1.67–12.49) and 278% (RR: 3.78; 95% CI: 1.39–10.27) increased risk of LBW respectively. Malaria infection, poor nutrition and indoor air pollution respectively mediated 10–21%, 16–44% and 31–52% of the observed effects of socioeconomic disadvantage on LBW risk.ConclusionWe provide evidence of the effects of socioeconomic deprivation, substantially mediated by malaria infection, poor nutrition and indoor air pollution, on pregnancy outcomes in a developing country setting.
Highlights
The rapid population growth of developing countries urban zones in recent years has led to the emergence and expansion of slum and squatter settlements in large parts of these areas with deplorable environmental conditions and widespread socioeconomic deprivation
There is mounting evidence linking socioeconomic deprivation with adverse pregnancy outcomes. Factors such as area deprivation, unmarried status, low education, low income and low occupational attainment have been associated with low birth weight [1,2,3,4,5,6,7] and preterm birth (,37 weeks of gestation) [4,7,8,9,10] in several populations
The construct of socioeconomic status (SES) was a strong determinant of birth weight and Low birth weight (LBW) risk with low and middle SES respectively associated with 357% (RR = 4.57, 95% CI: 1.67, 12.49) and 278% (RR = 3.78, 95% CI: 1.39, 10.27) increased risk of LBW
Summary
The rapid population growth of developing countries urban zones in recent years has led to the emergence and expansion of slum and squatter settlements in large parts of these areas with deplorable environmental conditions and widespread socioeconomic deprivation. Socioeconomic deprivation manifests as poor housing conditions, unemployment, low income and low educational attainment among others in these urban settlements with adverse consequences for human health. There is mounting evidence linking socioeconomic deprivation with adverse pregnancy outcomes Factors such as area deprivation, unmarried status, low education, low income and low occupational attainment have been associated with low birth weight (birth weight ,2500 grams) [1,2,3,4,5,6,7] and preterm birth (,37 weeks of gestation) [4,7,8,9,10] in several populations. Low birth weight (LBW) is a determinant of neonatal and infant mortality and morbidity, reduced growth, impaired immune function and poor cognitive development [11].
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
