Inequalities in perinatal and maternal health

Graaf, Johanna P. de; Steegers, Eric A.P.; Bonsel, Gouke J.

doi:10.1097/gco.0b013e32835ec9b0

Cited by 154 publications

(127 citation statements)

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“…[9,36,37] Despite recent studies stating that residents who live in deprived neighborhoods are difficult to motivate to change unhealthy behaviors [3,17,18], in our study, those women were more likely to complete the 24 weeks of mHealth coaching and improve their nutrition and lifestyle behaviors more than women who live in less deprived…”

Section: Comparison With Prior Workcontrasting

confidence: 46%

“…[16] However, behavioral change is more challenging for individuals who have limited health literacy or impaired financial resources, who are less educated, and live in more deprived neighborhoods. [3,17,18] From this background, we hypothesize that women who live in more deprived neighborhoods are less likely to improve inadequate nutrition and lifestyle behaviors before and during pregnancy compared to women who live in less deprived neighborhoods.…”

Section: Introductionmentioning

confidence: 99%

“…housing conditions and poverty) factors. [3][4][5][6] As in other countries, perinatal morbidity and mortality rates in the Netherlands also differ between districts, with particularly high mortality rates in the country's four largest cities. This is mainly due to the large number of deprived neighborhoods in these cities.…”

Section: Introductionmentioning

confidence: 99%

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Neighborhood Deprivation and the Effectiveness of Mobile Health Coaching to Improve Periconceptional Nutrition and Lifestyle in Women: Survey in a Large Urban Municipality in the Netherlands (Preprint)

Gootjes¹,

Dijk²,

Köster³

et al. 2018

Preprint

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Background: Living in a deprived neighborhood is associated with several adverse pregnancy outcomes. This can be explained by the accumulation of risk factors, such as inadequate nutrition and lifestyle behaviors, in residents who live in those deprived neighborhoods. In 2011, we launched the ''Smarter Pregnancy'' mHealth coaching program, which has proven to be effective to improve inadequate nutrition and lifestyle behaviors in women before and during pregnancy. We did not investigate before, whether this mHealth program is equally effective in women who live in deprived neighborhoods.Objective: To study the associations between neighborhood deprivation and improvement of inadequate nutrition and lifestyle behaviors of women before and during pregnancy who subscribed to the ''Smarter Pregnancy'' program. Methods:We analyzed data from women who were contemplating pregnancy or already had been pregnant and used the ''Smarter Pregnancy'' program between 2011-2016. The program consisted of 24 weeks of coaching on five nutrition and lifestyle behaviors of which adequate daily intakes or lifestyle behaviors were defined as an intake of ≥200 grams of vegetables, two pieces of fruit, daily folic acid supplement use of 400 µg per day, and no smoking or alcohol consumption. Neighborhood deprivation was determined according to the status scores of the Netherlands Institute for Social Research. Logistic regression analyses and generalized estimating equation models were used to assess the associations between the neighborhood status score (NSS) and the improvement of inadequate nutrition and lifestyle behaviors, adjusted for maternal age, body mass index, geographic origin, pregnancy status and participation as a couple.Results: A total of 2,554 women were included of whom 521 participated with their male partner. Overall, daily vegetable intake was most frequently inadequate at the start of the program (n=1,985; 77.7%). Women with a higher NSS (i.e. no deprived neighborhood) less often smoked (adjusted OR 0.85, 95%CI 0.77;0.93), more often consumed alcohol (adjusted OR 1.14, 95%CI 1.04;1.24) and were less likely to complete the 24 weeks of coaching (OR 0.91, 95%CI 0.88;0.95) compared to women who live in a neighborhood with a low NSS.In the total study group, the relative improvement of inadequate nutrition and lifestyle behaviors after 24 weeks of coaching was between 26% and 64%. NSS was negatively associated with this improvement, 2 indicating that women with a higher NSS were less likely to improve inadequate nutrition and lifestyle behaviors, especially vegetable intake (adjusted OR 0.89, 95%CI 0.82 ; 0.97). Conclusions:The ''Smarter Pregnancy'' mHealth coaching program empowers women to improve inadequate nutrition and lifestyle behaviors. Unexpectedly, the program seemed more effective in women who live in deprived neighborhoods. It is important to unravel differences in needs and behaviors of specific target groups in order to further tailor the mHealth program based on demographic characteristics, such a...

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Section: Comparison With Prior Workcontrasting

confidence: 46%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Neighborhood Deprivation and the Effectiveness of Mobile Health Coaching to Improve Periconceptional Nutrition and Lifestyle in Women: Survey in a Large Urban Municipality in the Netherlands (Preprint)

Gootjes¹,

Dijk²,

Köster³

et al. 2018

Preprint

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“…Previous research has focused on the impact of inequality due to social factors (e.g. low levels of education, low incomes) on physical and mental health [11][12][13][14]. However, what affects the pregnant womanʼs physical and psychological state of health is not so much her actual social status but instead the (socially determined) differences which manifest as specific burdens (e.g.…”

Section: Consequences and Possible Predictors Of Health-damaging Behamentioning

confidence: 99%

“…However, what affects the pregnant womanʼs physical and psychological state of health is not so much her actual social status but instead the (socially determined) differences which manifest as specific burdens (e.g. housing conditions and conditions of employment) in the availability or lack of resources, in the prevalence of health-damaging behaviors, and in her medical care [11][12]. These factors, in their turn, can affect the capacity of the expectant mother to adjust to a variety of physiological, psychological and social changes during the perinatal period [15].…”

Section: Consequences and Possible Predictors Of Health-damaging Behamentioning

confidence: 99%

Consequences and Possible Predictors of Health-damaging Behaviors and Mental Health Problems in Pregnancy – A Review

Ulrich

Petermann

2016

Geburtshilfe Frauenheilkd

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!In recent decades, the understanding of the short and longer term effects of health-damaging behaviors and mental health problems in pregnant women and the underlying mechanisms of these behaviors and illnesses has significantly increased. In contrast, little is known about the factors affecting individual pregnant women which contribute to health-damaging behaviors and mental illness. The aim of this paper was therefore to summarize the current state of research into the consequences of nicotine and alcohol consumption, malnutrition, excessive weight gain or obesity, and impaired mental health (depression and anxiety) during pregnancy. In addition, the characteristics of pregnant women which increase their risk of developing such behaviors or mental disorders are described. A better knowledge of these risks should make it easier for clinicians to identify cases at risk early on and put measures of support in place. A review of the literature has shown that certain characteristics of pregnant women (e.g. her relationship with her partner, a previous history of mental illness prior to pregnancy) are associated with various healthdamaging behaviors as well as with impaired mental health. Affected women often show an accumulated psychosocial stress which was already present prior to the pregnancy and which may persist even after the birth of the child. Zusammenfassung Consequences and Possible Predictors of Health-damaging Behaviors and Mental Health Problems in Pregnancy -A ReviewAuswirkungen und mögliche Prädiktoren gesundheitsschädigender Verhaltensweisen und psychischer Beeinträchtigungen in der Schwangerschaft -ein Überblick

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Association Between Income and Perinatal Mortality in the Netherlands Across Gestational Age

et al. 2021

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IMPORTANCEThe association between household income and perinatal health outcomes has been understudied. Examining disparities in perinatal mortality within strata of gestational age and before and after adjusting for birth weight centile can reveal how the income gradient is associated with gestational age, birth weight, and perinatal mortality.OBJECTIVES To investigate the association between household income and perinatal mortality, separately by gestational age strata and time of death, and the potential role of birth weight centile in mediating this association. DESIGN, SETTING, AND PARTICIPANTSThis cross-sectional study used individually linked data of all registered births in the Netherlands with household-level income tax records. Singletons born between January 1, 2004, and December 31, 2016, at 24 weeks to 41 weeks 6 days of gestation with complete information on birth outcomes and maternal characteristics were studied. Data analysis was performed from March 1, 2018, to August 30, 2021. EXPOSURES Household income rank (adjusted for household size).MAIN OUTCOMES AND MEASURES Perinatal mortality, stillbirth (at Ն24 weeks of gestation), and early neonatal mortality (at Յ7 days after birth). Disparities were expressed as bottom-to-top ratios of projected mortality among newborns with the poorest 1% of households vs those with the richest 1% of households. Generalized additive models stratified by gestational age categories, adjusted for potential confounding by maternal age at birth, maternal ethnicity, parity, sex, and year of birth, were used. Birth weight centile was included as a potential mediator. RESULTS Among 2 036 431 singletons in this study (1 043 999 [51.3%] males; 1 496 579 [73.5%] with mother of Dutch ethnicity), 121 010 (5.9%) were born before 37 weeks of gestation, and 8720 (4.3 deaths per 1000) died during the perinatal period. Higher household income was positively associated with higher rates of perinatal survival, with an unadjusted bottom-to-top ratio of 2.18 (95% CI, 1.87-2.56). The bottom-to-top ratio decreased to 1.30 (95% CI, 1.22-1.39) after adjustment for potential confounding factors and inclusion of birth weight centile as a possible mediator. The fully adjusted ratios were lower for stillbirths (1.27; 95% CI, 1.20-1.36) than for early neonatal deaths (1.35; 95% CI, 1.14-1.66). Inequalities in perinatal mortality were found for newborns at greater than 26 weeks of gestation but not between 24 and 26 weeks of gestation (fully adjusted bottom-to-top ratio, 0.89; 95% CI, 0.77-1.04). CONCLUSIONS AND RELEVANCEThe results of this large nationally representative cross-sectional study suggest that a large part of the increased risk of perinatal mortality among low-income women is mediated via a lower birth weight centile. The absence of disparities at very low gestational ages suggests that income-related risk factors for perinatal mortality are less prominent at very low (continued) Key Points Question Is higher household income associated with perinatal survival in a country with unive...

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Inequalities in perinatal and maternal health

Cited by 154 publications

References 96 publications

Neighborhood Deprivation and the Effectiveness of Mobile Health Coaching to Improve Periconceptional Nutrition and Lifestyle in Women: Survey in a Large Urban Municipality in the Netherlands (Preprint)

Neighborhood Deprivation and the Effectiveness of Mobile Health Coaching to Improve Periconceptional Nutrition and Lifestyle in Women: Survey in a Large Urban Municipality in the Netherlands (Preprint)

Consequences and Possible Predictors of Health-damaging Behaviors and Mental Health Problems in Pregnancy – A Review

Association Between Income and Perinatal Mortality in the Netherlands Across Gestational Age

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