Neighborhood Inequalities in Adverse Pregnancy Outcomes in an Urban Setting in Spain: A Multilevel Approach

Abstract

The aim of the present study was to describe socioeconomic inequalities in low birth weight (LBW), premature birth (PM) and small size for gestational age at birth (SGA) between 2000 and 2005 in Barcelona, Spain, jointly evaluating the effect of mother's country of origin, and neighborhood of residence socioeconomic level measured using unemployment and educational level. We performed a cross-sectional study of births to mothers aged 12-49 years who were residents in the city of Barcelona in 2000-2005, analyzing adverse pregnancy outcomes (n=61,676). Weighted multilevel logistic regression models were fitted with individual data on level 1 and neighborhood data on level 2, to obtain adjusted odds ratios (aOR) with 95% confidence intervals and residual variance. Individually, pregnancy outcomes are more favorable in births to older mothers and to mothers from Maghrib and Central and South America than from developed countries (including Spain) or from other developing countries. After adjusting for individual variables, poor pregnancy outcomes were associated with poor neighborhoods (more unemployment was associated to LBW: aOR =1.56; PM aOR = 1.51; SGA aOR =1.66). The same trend was observed for associations with illiteracy rate. The present study shows that there are socioeconomic inequalities in adverse pregnancy outcomes in the city of Barcelona. One of the main challenges in perinatal health continues to be the reduction of adverse pregnancy outcomes in the city.

Deprived neighborhoods and adverse perinatal outcome: a systematic review and meta‐analysis

“…Table summarizes the characteristics of the studies included in the systematic review ( n = 17) and meta‐analysis ( n = 7). Many articles presented results for multiple outcomes.…”

Is the economic crisis affecting birth outcome in Spain? Evaluation of temporal trend in underweight at birth (2003–2012)

“…Our conclusion is that the greater increase in the prevalence and risk of underweight at birth since 2008 compared with the previous period of economic growth, and in all maternal and foetal categories analysed, confirm the widespread impact of economic recession on Spanish society, which cannot be explained just as a continuation of pre-crisis trends in reproductive behaviour and maternal profile. Social and economic inequalities in poor pregnancy outcomes persisted in Spain in the years preceding the economic crisis (García-Subirats et al, 2012), and it was to be expected that the current situation had widened this gap. This impact probably occurs through the combination of increased psychosocial stress-even in the better-off strata-and worsening socioeconomic conditions, although our data do not allow us to go further into the mechanisms affecting maternal environment and birth outcomes, as the information offered by the Spanish birth certificate is limited.…”

Small and large size for gestational age and neighborhood deprivation measured within increasing proximity to homes

“…Neighborhood socioeconomic deprivation is hypothesized to affect maternal health both through psychosocial factors and through access to material resources (Daniel, et al, 2008; Culhane and Elo, 2005; Schempf, et al, 2009). In a large body of literature, neighborhood deprivation is a strong, consistent predictor of low birthweight, preterm birth, and small for gestational age (SGA) (Sundquist, et al, 2011; Elo, et al, 2009; Janevic, et al, 2010; Zeka, et al, 2008; Agyemang, et al, 2009; Masi, et al, 2007; Farley, et al, 2006; Subramanian, et al, 2006; Schempf, et al, 2009; Nkansah-Amankra, et al, 2010; Collins, et al, 2009; Auger, et al, 2013; Buka, et al, 2003; Beard, et al, 2009; Garcia-Subirats, et al, 2012; Messer, et al, 2008). However, associations between neighborhood context and large for gestational age (LGA) have received little consideration.…”