Perinatal Health Indicators Research Articles

Defining Preterm Birth and Stillbirth in the Western Pacific: A Systematic Review.

Preterm birth and stillbirth are important global perinatal health indicators. Definitions of these indicators can differ between countries, affecting comparability of preterm birth and stillbirth rates across countries. This study aimed to document national-level adherence to World Health Organization (WHO) definitions of preterm birth and stillbirth in the WHO Western Pacific region. A systematic search of government health websites and 4 electronic databases was conducted. Any official report or published study describing the national definition of preterm birth or stillbirth published between 2000 and 2020 was eligible for inclusion. A total of 58 data sources from 21 countries were identified. There was considerable variation in how preterm birth and stillbirth was defined across the region. The most frequently used lower gestational age threshold for viability of preterm birth was 28 weeks gestation (range 20-28 weeks), and stillbirth was most frequently classified from 20 weeks gestation (range 12-28 weeks). High-income countries more frequently used earlier gestational ages for preterm birth and stillbirth compared with low- to middle-income countries. The findings highlight the importance of clear, standardized, internationally comparable definitions for perinatal indicators. Further research is needed to determine the impact on regional preterm birth and stillbirth rates.

Quality of maternal and newborn hospital care in Brazil: a quality improvement cycle using the WHO assessment and quality tool.

Increasing efforts toward quality improvement (QI) are necessary in low- and middle-income countries (LMICs) to reduce maternal and perinatal mortality and morbidity and to promote respectful care. In Brazil, perinatal health indicators are below targets in several states despite universal access to perinatal services and very high rates of institutional births, indicating poor quality of care (QoC) as a key issue to be addressed. However, research efforts to develop and test QoC improvement interventions are scarce. We assessed the effects of a 1-year comprehensive QI cycle using a World Health Organization (WHO) assessment and quality tool on maternal and newborn care at hospital level and documented QIs obtained after a 1-year comprehensive QI cycle. Uncontrolled, unblinded, pre-post study carried out in six maternity hospitals in Pernambuco, Brazil, accounting for 29 128 live births in 2014. A standards-based and participatory approach based on a WHO quality assessment and improvement tool for maternal and neonatal care at hospital level was used. A national team of assessors supervised by international experts carried out baseline and final assessments. An action plan was developed and implemented to address key quality gaps emerging from the baseline assessment and from two supportive supervision visits. At baseline, hospitals presented a variety of quality gaps, the majority common to all participating centers. Gaps in case management of normal and complicated deliveries and in respectful and holistic care were predominant, in both teaching/tertiary and secondary care hospitals. After one year, several improvements were observed, particularly in respectful care during labor and at delivery, in case management of normal labor and delivery and in neonatal care. A systematic participatory approach based on a WHO tool produced important QIs in a relatively short time and should be considered for use for large-scale QI programs in Brazil and other LMICs. Its comprehensive, peer-to-peer and action-oriented nature and its capability to document QI over time and to build a QI culture represent important comparative advantages over other QI interventions.

Twin pregnancy and perinatal outcomes: Data from ‘Birth in Brazil Study’

Twin pregnancies account for 0.5-2.0% of all gestations worldwide. They have a negative impact on perinatal health indicators, mainly owing to the increased risk for preterm birth. However, population-based data from low/middle income countries are limited. The current paper aims to understand the health risks of twins, compared to singletons, amongst late preterms and early terms. Data is from "Birth in Brazil", a national inquiry into childbirth care conducted in 2011/2012 in 266 maternity hospitals. We included women with a live birth or a stillborn, and excluded births of triplets or more, totalling 23,746 singletons and 554 twins. We used multiple logistic regressions and adjusted for potential confounders. Twins accounted for 1.2% of gestations and 2.3% of newborns. They had higher prevalence of low birth weight and intrauterine growth restriction, when compared to singletons, in all gestational age groups, except in the very premature ones (<34 weeks). Amongst late preterm's, twins had higher odds of jaundice (OR 2.7, 95% CI 1.8-4.2) and antibiotic use (OR 1.8, 95% CI 1.1-3.2). Amongst early-terms, twins had higher odds of oxygen therapy (OR 2.7, 95% CI 1.3-5.9), admission to neonatal intensive care unit (OR 3.1, 95% CI 1.5-6.5), transient tachypnoea (OR 3.7, 95% CI 1.5-9.2), jaundice (OR 2.8, 95% CI 1.3-5.9) and antibiotic use (OR 2.2, 95% CI 1.14.9). In relation to birth order, the second-born infant had an elevated likelihood of jaundice, antibiotic use and oxygen therapy, than the first-born infant. Although strongly mediated by gestational age, an independent risk remains for twins for most neonatal morbidities, when compared to singletons. These disadvantages seem to be more prominent in early-term newborns than in the late preterm ones.

Global Maternal and Perinatal Health Indicators

Global Maternal and Perinatal Health Indicators

Perinatal health predictors using artificial intelligence: A review.

Advances in public health and medical care have enabled better pregnancy and birth outcomes. The rates of perinatal health indicators such as maternal mortality and morbidity; fetal, neonatal, and infant mortality; low birthweight; and preterm birth have reduced over time. However, they are still a public health concern, and considerable disparities exist within and between countries. For perinatal researchers who are engaged in unraveling the tangled web of causation for maternal and child health outcomes and for clinicians involved in the care of pregnant women and infants, artificial intelligence offers novel approaches to prediction modeling, diagnosis, early detection, and monitoring in perinatal health. Machine learning, a commonly used artificial intelligence method, has been used to predict preterm birth, birthweight, preeclampsia, mortality, hypertensive disorders, and postpartum depression. Real-time electronic health recording and predictive modeling using artificial intelligence have found early success in fetal monitoring and monitoring of women with gestational diabetes especially in low-resource settings. Artificial intelligence–based methodologies have the potential to improve prenatal diagnosis of birth defects and outcomes in assisted reproductive technology too. In this scenario, we envision artificial intelligence for perinatal research to be based on three goals: (1) availability of population-representative, routine clinical data (rich multimodal data of large sample size) for perinatal research; (2) modification and application of current state-of-the-art artificial intelligence for prediction and classification in health care research to the field of perinatal health; and (3) development of methods for explaining the decision-making processes of artificial intelligence models for perinatal health indicators. Achieving these three goals via a multidisciplinary approach to the development of artificial intelligence tools will enable trust in these tools and advance research, clinical practice, and policies to ensure optimal perinatal health.

Health and Well-Being Outcomes of Adolescents Conceived Through In Vitro Fertilization and Intracytoplasmic Sperm Injection.

What is the perception of health and well-being of adolescents from an assisted reproductive technology (ART) cohort? We conducted a survey, from September 2015 to June 2016, through self-completion questionnaires, on 487 singleton or twin ART-conceived 11- to 15-year-old adolescents, followed up since 1994, as part of an ART cohort. Collected data concerned perinatal characteristics, health indicators and perception, eating habits, behavior, and living standards. A total of 60.6% of the questionnaires were returned and could therefore be analyzed. This concerned 295 adolescents who were representative of the 788 remaining adolescents of our cohort, in terms of type of ART, maternal and perinatal characteristics, but not gender (sex ratio = 0.77). Overall, 15.3% reported chronic diseases, and only 13.3% of them considered that their chronic disease had an impact on their school life. Moreover, 94.2% of adolescents perceived that their health was "excellent" or "good"; 97.3% adolescents had normal weight or were underweight; onset of menstruation was 12years old (± 1) for girls, age usually reported for puberty in girls; 51.9% declared having regular physical activity, boys more frequently than girls. Moreover, 70.6% of the boys had a sedentary behavior compared to 44.8% of the girls. A total of 73.5% of the adolescents were stressed at school, but school demand was considered high only in 12.2% of cases. Finally, 90% declared to have high life satisfaction. Overall, ART does not appear to have particular effect on the health indicators and behavior of adolescents who participated in the survey except for higher family affluence scale.

The Effect of Immigration on Adverse Perinatal Outcomes: Analysis of Experiences at a Turkish Tertiary Hospital.

Introduction In literature, it is well documented that migration is associated with adverse perinatal outcomes in many countries over the world. But in Turkey, health care providers and obstetricians had to face the effects of migration for the first time after civil war in Syria. Hence, this situation motivated us to conduct the current research in Turkey. Also we aimed to evaluate the effect of immigration on adverse perinatal outcomes, comparing the obstetric results of a native population and an immigrant population, and focusing on relevant indicators of perinatal health. Methods Information from the hospital database of pregnant women who had vaginal or cesarean delivery was evaluated. The patients were divided into two groups, native women and immigrant women, according to their ethnic origin. Adverse perinatal outcomes were compared between groups using multivariate regression models. Adjusted odds ratio (aOR) and 95% confidence interval (CI) were calculated. Results A total of 6311 patients were evaluated, of which 4271 were classified as native and 2040 were classified as immigrants. Mean hemoglobin level before delivery was significantly lower in the immigrant group. Preterm delivery (aOR: 1.41; 95% CI: 1.19–1.65), stillbirth (aOR: 1.88; 95% CI: 1.09–3.23), red blood cell transfusion requirement (aOR: 3.12; 95% CI: 2.02–3.98), unplanned birth rates before hospital arrival (aOR: 2.25; 95% CI: 1.53–3.31), and postpartum infection rates (aOR:2.12; 95% CI: 1.48–3.08) were significantly increased in the immigrant group compared with native group, even considering adjustment for potential confounders. Conclusion The immigration may be an important and independent risk factor for some adverse maternal and neonatal outcomes.

Tracking pregnant women displacements in Sao Paulo, Brazil: a complex systems approach to regionalization through the emergence of patterns

BackgroundThe healthcare system can be understood as the dynamic result of the interaction of hospitals, patients, providers, and government configuring a complex network of reciprocal influences. In order to better understand such a complex system, the analysis must include characteristics that are feasible to be studied in order to redesign its functioning. The analysis of the emergent patterns of pregnant women flows crossing municipal borders for birth-related hospitalizations in a region of São Paulo, Brazil, allowed to examine the functionality of the regional division in the state using a complex systems approach and to propose answers to the dilemma of concentration vs. distribution of maternal care regional services in the context of the Brazilian Unified Health System (SUS).MethodsCross-sectional research of the areas of influence of hospitals using spatial interaction methods, recording the points of origin and destination of the patients and exploring the emergent patterns of displacement.ResultsThe resulting functional region is broader than the limits established in the legal provisions, verifying that 85% of patients move to hospitals with high technology to perform normal deliveries and cesarean sections. The region has high independence rates and behaves as a “service exporter.” Patients going to centrally located hospitals travel twice as long as patients who receive care in other municipalities even when the patients’ conditions do not demand technologically sophisticated services. The effects of regulation and the agents’ preferences reinforce the tendency to refer patients to centrally located hospitals.ConclusionsDisplacement of patients during delivery may affect indicators of maternal and perinatal health. The emergent pattern of movements allowed examining the contradiction between wider deployments of services versus concentration of highly specialized resources in a few places. The study shows the potential of this type of analysis applied to other type of patients’ flows, such as cancer or specialized surgery, as tools to guide the regionalization of the Brazilian Health System.

Perinatal health of refugee and asylum-seeking women in Sweden 2014-17: a register-based cohort study.

BackgroundAn increasing number of migrants have fled armed conflict, persecution and deteriorating living conditions, many of whom have also endured risky migration journeys to reach Europe. Despite this, little is known about the perinatal health of migrant women who are particularly vulnerable, such as refugees, asylum-seekers, and undocumented migrants, and their access to perinatal care in the host country.MethodsUsing the Swedish Pregnancy Register, we analyzed indicators of perinatal health and health care usage in 31 897 migrant women from the top five refugee countries of origin between 2014 and 2017. We also compared them to native-born Swedish women.ResultsCompared to Swedish-born women, migrant women from Syria, Iraq, Somali, Eritrea and Afghanistan had higher risks of poor self-rated health, gestational diabetes, stillbirth and infants with low birthweight. Within the migrant population, asylum-seekers and undocumented migrants had a higher risk of poor maternal self-rated health than refugee women with residency, with an adjusted risk ratio (RR) of 1.84 and 95% confidence interval (95% CI) of 1.72–1.97. They also had a higher risk of preterm birth (RR 1.47, 95% CI 1.21–1.79), inadequate antenatal care (RR 2.56, 95% CI 2.27–2.89) and missed postpartum care visits (RR 1.15, 95% CI 1.10–1.22).ConclusionRefugee, asylum-seeking and undocumented migrant women were vulnerable during pregnancy and childbirth. Living without residence permits negatively affected self-rated health, pregnancy and birth outcomes in asylum-seekers and undocumented migrants. Pregnant migrant women’s special needs should be addressed by those involved in the asylum reception process and by health care providers.

Impact of timing of methadone initiation on perinatal outcomes following delivery among pregnant women on methadone maintenance therapy in Ontario.

Methadone maintenance therapy (MMT) is associated with improved outcomes for children exposed to maternal opioid dependence in utero. We examined Ontario's population of pregnant women on MMT and determined the impact of timing of MMT initiation on perinatal outcomes. Cohort study. Ontario, Canada. Women eligible for public drug benefits and on MMT during pregnancy between 2005 and 2015. We stratified women based on their timing of MMT initiation: (1) stabilized prior to conception, (2) newly initiated prior to conception, (3) initiation in trimester 1, (4) initiation in trimester 2 or (5) initiation in trimester 3. The primary outcomes in the multivariable logistic regression analysis were key perinatal health indicators: small for gestational age, preterm birth, congenital anomalies, severe maternal morbidity, caesarean section and induced labor. Secondary outcomes were specific to maternal opioid dependence: neonatal abstinence syndrome (NAS), admission to a neonatal intensive care unit (NICU), NAS treatment, removal from mother's custody at hospital discharge and neonatal death. Among 1842 women on MMT during pregnancy, 87.6% (n=1614) initiated MMT before conception. Almost a quarter of their infants (22.2%; n=408) were born small for gestational age, 17.5% (n=323) were preterm and 5.9% (n=109) were born with a congenital anomaly. The odds of primary outcomes occurring did not differ based on timing of methadone initiation; however, infants of mothers who initiated methadone during pregnancy had up to a fourfold increase in the odds of social services removal at the hospital [adjusted odds ratio (aOR) range=3.70-4.19] compared with those whose mothers were stabilized on MMT prior to conception. Later initiation of methadone maintenance therapy among pregnant women in Ontario, Canada has not been found to be clearly related to most key perinatal adverse health outcomes.

Impacts of online and group perinatal education: a mixed\xa0methods study protocol for the optimization of perinatal health services

BackgroundPrenatal education is a core component of perinatal care and services provided by health institutions. Whereas group prenatal education is the most common educational model, some health institutions have opted to implement online prenatal education to address accessibility issues as well as the evolving needs of future parents. Various studies have shown that prenatal education can be effective in acquisition of knowledge on labour and delivery, reducing psychological distress and maximising father’s involvement. However, these results may depend on educational material, organization, format and content. Furthermore, the effectiveness of online prenatal education compared to group prenatal education remains unclear in the literature. This project aims to evaluate the impacts of group prenatal education and online prenatal education on health determinants and users’ health status, as well as on networks of perinatal educational services maintained with community-based partners.MethodsThis multipronged mixed methods study uses a collaborative research approach to integrate and mobilize knowledge throughout the process. It consists of: 1) a prospective cohort study with quantitative data collection and qualitative interviews with future and new parents; and 2) a multiple case study integrating documentary sources and interviews with stakeholders involved in the implementation of perinatal information service networks and collaborations with community partners. Perinatal health indicators and determinants will be compared between prenatal education groups (group prenatal education and online prenatal education) and standard care without these prenatal education services (control group).DiscussionThis study will provide knowledge about the impact of online prenatal education as a new technological service delivery model compared to traditional group prenatal education. Indicators related to the complementarity of these interventions and those available in community settings will refine our understanding of regional perinatal services networks. Results will assist decision-making regarding service organization and delivery models of prenatal education services.Protocol versionVersion 1 (February 9 2018).

Decreasing prevalence and severity of cerebral palsy in Norway among children born 1999 to 2010 concomitant with improvements in perinatal health.

The aim of our study was to explore if the prevalence and clinical characteristics of cerebral palsy (CP), concomitant with perinatal health indicators in the general population, remained unchanged for children born in Norway between 1999 and 2010. This national multi-register cohort study included 711174 children recorded in the Medical Birth Registry of Norway. Among these, 707916 were born alive, and 1664 had a validated diagnosis of CP recorded in the Cerebral Palsy Registry of Norway and/or the Norwegian Patient Registry. Prevalence per 1000 live births as a function of birth year was analyzed using logistic regression with fractional polynomials to allow for non-linear trends. Chi-square statistics were used to estimate trends in proportions of clinical characteristics. The prevalence of CP in Norway decreased from 2.62 per 1000 live births in 1999 to 1.89 in 2010. The reduction was most evident among children with bilateral CP, in particular those with diplegia. During the study period, the proportions of children with severe motor impairments, epilepsy, intellectual impairment and reduced speech also decreased. At the same time, perinatal mortality has decreased in Norway, along with the proportion of women with preeclampsia, children born preterm or as a multiple. We observed a significant decrease in the prevalence and severity of CP subtypes and associated impairments among children with CP in Norway. This coincided with improvements in perinatal health indicators in the general population. These improvements are most likely explained by advancements in obstetric and neonatal care.

Migrace a porod: sociální aspekty prolínání dvou životních změn ve výzkumu perinatálního zdraví žen

When the experiences of migration and becoming a mother intersect, the context and conditions of this have implications for the health of the women and their children. This article presents an overview of social-science research on health and pregnancy among migrant women and on the perinatal and postpartum care they receive. Research on 124 studies on this subject revealed that there are three main themes associated with maternal health in this context: (1) How women are defined and categorised as migrants: This is often based on a single indicator, country of origin or birth. This creates a simplified and homogenising category that then also serves as the basis for the use of more complex categories. (2) The significance of social support for families, especially with respect to informal care, and the fundamental role of language and language barriers in health care. The relationship between migrant women and health-care providers is impacted by cultural differences, which leave women in a vulnerable position. (3) Macro-sociological and epidemiological factors. These are discussed mainly from the perspective of the 'epidemiological paradox', which the authors here deem a rhetorical trick because it conceals the variableness of the findings obtained from perinatal health indicators.

Maternal Profile, Assisted Reproductive Technology, and Perinatal Health Indicators

Maternal Profile, Assisted Reproductive Technology, and Perinatal Health Indicators

Perinatal health and malocclusions in preschool children: Findings from a cohort of adolescent mothers in Southern Brazil.

Pregnancy in adolescence has long-term consequences that can negatively influence oral conditions. In this study, we aimed to assess malocclusion in deciduous dentition and its association with prolonged breastfeeding, pacifier use, and perinatal health indicators pertaining to the periods immediately before and after birth. This cross-sectional study was nested in a cohort of adolescent mothers who became pregnant from 13 to 19years of age (mean age, 17.3±1.6years). A total of 509mother-child dyads were included. Information on perinatal indicators, including Apgar score (0-10), which is a standardized assessment of the condition of the infant at birth (heart rate, breath rate, muscle tone, reflex irritability, and skin color), head circumference, birth weight, and need for intensive care unit admission were collected after delivery through interviews with the mothers. By the time the children were 24 to 36months of age, malocclusion was assessed, and information on the use of pacifiers and breastfeeding was collected. Multivariate Poisson regression was used to assess the effect of independent variables on the outcome (malocclusion). The prevalence of malocclusion was 62.33%, and open bite was the most frequent one (47.45%). After adjustments, children with no need for intensive care unit admission had a lower risk of malocclusion (prevalence ratio [PR]=0.75; 95% CI, 0.56-0.99), whereas those with an Apgar score less than 7 had a higher risk (PR=1.32; 95% CI, 1.06-1.64). Children who had used a pacifier (PR=1.82; 95% CI, 1.02-3.24) or were still using it (PR=3.88; 95% CI, 2.65-5.68) had a higher chance of malocclusion compared with children who never used a pacifier. Children breastfeeding for 24months or longer were less likely to have malocclusion (PR=0.46; 95% CI, 0.34-0.73). Poor perinatal health and pacifier use may be risk factors for malocclusion development in deciduous teeth. Long duration of breastfeeding is associated with better occlusal conditions in children of adolescent mothers. Further studies are needed with other age groups.

Trends in perinatal health in metropolitan France from 1995 to 2016: Results from the French National Perinatal Surveys

ObjectiveTo study trends in the main indicators of perinatal health, medical practices and risk factors in France since 1995. Population and methodAll live births during one week in 1995 (n=13,318), 2003 (n=14,737), 2010 (n=14,903) and 2016 (n=13,384). Data were from interviews of women in postpartum wards and from medical records and were compared between years. ResultsBetween 1995 and 2016, maternal age and body mass index increased steadily. Pregnancies that occurred with use of contraception increased from 7.4% in 2010 to 9.3% in 2016. Smoking during pregnancy (16.6%) did not decrease since 2010. The frequency of more than three ultrasounds during pregnancy was 48.5% in 1995 and 74.7% in 2016. Deliveries in large public hospitals increased steadily. The caesarean section rate has been relatively stable since 2003 (20.4% in 2003, 21.1% in 2010 and 20.4% in 2016). The rate of induction of labour was 22% in 2010 and 2016. Overall, 83.8% of women had epidural analgesia/anaesthesia in 2016. Rates of pre-term birth in 2016 ranged from 7.5% among all live births to 6.0% among live born singletons; for singletons, this rate increased steadily from 1995 to 2016, whereas there was no clear trend for low birth weight. Exclusive breastfeeding decreased from 60.3% in 2010 to 52.2% in 2016. ConclusionRoutine national perinatal surveys highlight successful policies and recommendations but also point out some health indicators, practices, preventive behaviours and risk factors that need special attention.

CLINICAL AND METABOLIC STATUS OF SMALL FOR GESTATIONAL AGE PRETERM INFANTS

Research objective: to study the characteristics of the perinatal status and health indicators of preterm infants born to the term of gestation, depending on the gestational age. 73 preterm infants born to the term of gestation were examined. The observation group (n=21) is a “moderately prererm” with a median gestation period of 33 weeks (32; 34), a comparison group (n=52) — “late” prematurity with a median gestation period of 35 weeks (35; 36). The course of the antenatal, intranatal and neonatal period was evaluated. Results: Perinatal outcomes were determined by gestational age. Preterm infants classified as moderately preterm had more severe health outcomes with a high incidence of intranatal asphyxia, metabolic disadaptation, respiratory disorders, hypoxic intracranial hemorrhages, anemia. However, “late” preterm represent a high-risk group for adverse perinatal outcomes and no less attention to neonatology. Conclusion: The delay in intrauterine development in premature infants is due to a complex of unfavorable perinatal factors and is associated with a high incidence of clinical and metabolic disturbances of postnatal adaptation, neonatal diseases, whose nature is determined by gestational age.

Differences in perinatal health between immigrant and native-origin children: Evidence from differentials in birth weight in Spain

1. The relevance of birth weight, and its determinants in the Spanish contextBirth weight has been the object of extensive research in various fields of scientific enquiry, from medicine to social epidemiology, sociology, and demography. The study of the adverse consequences of unhealthy weights at birth (4,000/4,500 grams) has mainly focused on health and educational outcomes. Because of the huge amount of evidence linking Low Birth Weight (LBW) to adverse health and cognitive outcomes, social epidemiology has tried extensively to assess the prevalence of LBW in different settings and different subsamples of the population (see, for instance, Reichman 2005, Teitler et al. 2007, Buekens et al. 2013). Although scholars have traditionally privileged the study of Low Birth Weight (LBW), research on High Birth Weight (HBW) is gaining momentum. In this review we briefly summarize both the determinants and consequences of deviation from healthy weights.On the one hand, the World Health Organisation defines LBW as less than 2,500 grams, irrespective of the gestational age of the infant. In the specialized literature it is interpreted as one of the most straightforward indicators of perinatal health and of infant health more generally. According to the American Academy of Paediatrics, LBW has different origins, ranging from the most obvious - those associated with genetic factors (foetal chromosomal abnormalities), the mother's health (high blood pressure, heart or kidney disease), and the mother's lifestyle (incorrect nutrition during gestation, smoking, and the consumption of other substances) - to problems with the development of the placenta (intra-amniotic infection, placental abruption, and placental insufficiency).LBW correlates with infant morbidity and mortality. Smaller babies are more likely to experience severe health risks after birth, and the effects of this early disadvantage are long-lasting: they are more prone to report general worse health later in life (Johnson and Schoeni 2007) and to suffer from a higher incidence of specific conditions such as diabetes, asthma, coronary disease, metabolic syndrome, and high blood pressure (Barker 1995, Johnson and Schoeni 2011). The negative impact of LBW on cognitive development and educational outcomes (Hack et al. 1995) has been shown to be similarly enduring. These children show poorer school readiness (Reichman 2005), evidence of increased school difficulties and hyperactivity until the age of 18 (McCormick et al. 1990), lower chances of completing high school at the standard age, lower educational attainment (Conley and Bennet 2000), and even lower earnings as adults (Black et al. 2007).However, socio-economic factors tend to mediate these relationships. Large differences in the incidence of LBW have consistently been reported across socio-economic groups in different countries (Kramer et al. 2000). Whereas more maternal resources . whether a higher educational level (Boardman et al. 2002), social class (Pattenden et al. 1999), or a supportive social and emotional climate (Hohmann-Marriott 2009) . all tend to improve birth outcomes, pregnancy later in life (Luke and Brown 2007) and non-marital birth (Castro-Martin 2010) are associated with an increased risk of LBW. Interestingly, according to the literature, in a number of affluent countries immigrant women tend to experience better birth outcomes than native women (see Guendelman et al. 1999), a result that will be discussed in the next section.Spain is no exception in this general picture. There are significant traces of inequality in perinatal health according to social background. Castro-Martin (2010) showed that the children of unmarried mothers suffer a higher risk of low birth weight, suggesting that the health disadvantage of children of non-marital couples is significant, even though recent social acceptance of non-marital unions and the selection of couples into this new form of cohabitation have helped to reduce it over time. …

Linking databases on perinatal health: a review of the literature and current practices in Europe.

Background: International comparisons of perinatal health indicators are complicated by the heterogeneity of data sources on pregnancy, maternal and neonatal outcomes. Record linkage can extend the range of data items available and thus can improve the validity and quality of routine data. We sought to assess the extent to which data are linked routinely for perinatal health research and reporting. Methods: We conducted a systematic review of the literature by searching PubMed for perinatal health studies from 2001 to 2011 based on linkage of routine data (data collected continuously at various time intervals). We also surveyed European health monitoring professionals about use of linkage for national perinatal health surveillance. Results: 516 studies fit our inclusion criteria. Denmark, Finland, Norway and Sweden, the US and the UK contributed 76% of the publications; a further 29 countries contributed at least one publication. Most studies linked vital statistics, hospital records, medical birth registries and cohort data. Other sources were specific registers for: cancer (70), congenital anomalies (56), ART (19), census (19), health professionals (37), insurance (22) prescription (31), and level of education (18). Eighteen of 29 countries (62%) reported linking data for routine perinatal health monitoring. Conclusion: Research using linkage is concentrated in a few countries and is not widely practiced in Europe. Broader adoption of data linkage could yield substantial gains for perinatal health research and surveillance.

Inégalités sociales en santé périnatale

Social insecurity is a known perinatal risk factor but beyond that, a social gradient in perinatal health is observable. This social gradient is particularly visible for the risk of neonatal mortality from congenital anomalies, premature delivery, and low birth weight. Analysis of mechanisms that would explain how the different dimensions of the social status of women interact with perinatal health indicators are not to this day fully understood. However, numbers of intermediate factors related to both the social status and perinatal risk have been identified. Among them, smoking, drug use, exposure to psychological and physical stress, genital infections, access to care, or drudgery. Finally, it was observed that the interaction of social conditions with the level of maternal education, geographic or ethnic origin, and the environment in which women live are complex and make the generalization of data obtained in a particular context sensitive.