Abstract
Fetal growth is an important risk factor for infant morbidity and mortality. In turn, socioeconomic status is a key predictor of fetal growth; however, other sociodemographic factors and environmental effects may also be important. This study modelled geographic variation in poor fetal growth after accounting for socioeconomic status, with a fixed effect for socioeconomic status and a combination of spatially-correlated and spatially-uncorrelated random effects. The dataset comprised 88,246 liveborn singletons, aggregated within suburbs in Perth, Western Australia. Low socioeconomic status was strongly associated with an increased risk of poor fetal growth. An increase in geographic variation of poor fetal growth from 1999–2001 (interquartile odds ratio among suburbs = 1.20) to 2004–2006 (interquartile odds ratio = 1.40) indicated a widening risk disparity by socioeconomic status. Low levels of residual spatial patterns strengthen the case for targeting policies and practices in areas of low socioeconomic status for improved outcomes. This study indicates an alarming increase in geographic inequalities in poor fetal growth in Perth which warrants further research into the specific aspects of socioeconomic status that act as risk factors.
Highlights
Fetal growth is a key predictor of infant health
By adjusting for socioeconomic status and using a measure of fetal growth that adjusts for parity and maternal height, this study provides a strong test for spatial patterns in poor fetal growth beyond a socioeconomic effect
In the absence of environmental candidates for these changes, we propose that the patterns of residual variation may be caused by shifting spatial patterns of sociodemographic composition not captured by the index used to model socioeconomic status
Summary
Fetal growth is a key predictor of infant health. Infants with poor fetal growth have greater risks of morbidity and mortality [1,2], birth defects [3], and poor health outcomes later in life [4]. Factors that in turn predict fetal growth may provide a basis for preventive interventions to improve birth outcomes and child development at the population level. Maternal risk factors include low socioeconomic status, smoking and alcohol consumption during pregnancy, poor fetal growth among previous pregnancies, and low maternal weight [5,6,9,10,11]. Neighbourhood-level effects, where demonstrated beyond individual circumstance, indicate an impact of the broader social environment on fetal growth [14]. The remaining challenges lie in resolving causal pathways, and in applying analytical methods to identify the relative roles of modifiable risk factors in populations of interest [17]
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 callMore From: International Journal of Environmental Research and Public Health
Disclaimer: 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.
