Abstract
BackgroundMaternal socioeconomic disparities strongly affect child health, particularly in low and middle income countries. We assessed whether neonatal outcomes varied by maternal education in a setting where healthcare system provides universal coverage of health services to all women, irrespective of their socioeconomic status.MethodsA population-based study was performed on 383,103 singleton live births occurring from 2005 to 2010 in Lombardy, an Italian region with approximately 10 million inhabitants. The association between maternal education, birthplace and selected neonatal outcomes (preterm birth, low birth weight, small-for-gestational age, low 5-min Apgar score, severe congenital anomalies, cerebral distress and respiratory distress) was estimated by fitting logistic regression models. Model adjustments were applied for sociodemographic, reproductive and medical maternal traits.ResultsCompared with low-level educated mothers, those with high education had reduced odds of preterm birth (Odds Ratio; OR = 0.81, 95% CI 0.77–0.85), low birth weight (OR = 0.78, 95% CI 0.70–0.81), small for gestational age (OR = 0.82, 95% CI 0.79–0.85), and respiratory distress (OR = 0.84, 95% CI 0.80–0.88).Mothers born in a foreign country had higher odds of preterm birth (OR = 1.16, 95% CI 1.11–1.20), low Apgar score (OR = 1.18, 95% CI 1.07–1.30) and respiratory distress (OR = 1.19, 95% CI 1.15–1.24) than Italian-born mothers. The influence of maternal education on neonatal outcomes was confirmed among both, Italian-born and foreign-born mothers.ConclusionsLow levels of education and maternal birthplace are important factors associated with adverse neonatal outcomes in Italy. Future studies are encouraged to investigate factors mediating the effects of socioeconomic inequality for identifying the main target groups for interventions.
Highlights
Maternal socioeconomic disparities strongly affect child health, in low and middle income countries
For the purpose of the current study, the following databases were considered: (i) the archive of beneficiaries of the Regional Health Service (RHS), i.e., the entire resident population, reporting demographic and administrative data, (ii) the database on diagnosis at discharge from public or private hospitals of Italy; and (iii) the database reporting Certificates of Delivery Assistance (CeDAP) including information self-reported by the mother relating to her socioeconomic traits in the period recent to her current pregnancy, other than medical information relating to pregnancy, childbirth, and child presentation at delivery
Just over 1 in 20 newborns were found to be affected from low birth weight, respiratory distress (5.1%), preterm birth (5.3%), small for gestational age (7.8%) and severe congenital anomalies (5.0%)
Summary
Maternal socioeconomic disparities strongly affect child health, in low and middle income countries. We assessed whether neonatal outcomes varied by maternal education in a setting where healthcare system provides universal coverage of health services to all women, irrespective of their socioeconomic status. Maternal socioeconomic status (SES) strongly affects child health [1,2,3,4,5,6], likely attributed to delayed prenatal care, preterm delivery and adverse birth outcomes [7,8,9,10,11,12,13,14]. The Italian National Health Service (NHS) provides universal coverage for many areas of healthcare, including obstetric, neonatal and related health care services to women, Cantarutti et al BMC Pregnancy and Childbirth (2017) 17:221 regardless of their SES [18]. Our analysis took into consideration other maternal features (i.e., maternal birthplace, sociodemographic factors, reproductive history, and medical conditions), as well as investigating the impact of all maternal traits
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