Pregnancy vulnerability in urban areas: a pragmatic approach combining behavioral, medico-obstetrical, socio-economic and environmental factors

Abstract

Multiple risk factors are associated with adverse pregnancy outcomes (APO), but how all these different factors combine and accumulate remains unknown. The objective of this observational retrospective study was to describe the accumulation of multiple vulnerability markers in pregnant women living in an urban area. Women living in Besançon (France) who delivered between 2005 and 2009 were included. Individual data were collected from the obstetrical records while environmental exposures were collected using environmental prediction models. The accumulation of 15 vulnerability markers, grouped into six dimensions (maternal age, smoking, body mass index (BMI), socio-economic, medico-obstetrical and environmental vulnerabilities) was described and analyzed in comparison with four APO. Among the 3686 included women, 20.8% were aged under 20 or over 34 and 21.9% had an extreme pre-pregnancy BMI. 18.8% declared smoking during pregnancy. Women exposed to socio-economic, medico-obstetrical or environmental vulnerability were 14.2%, 31.6% and 42.4% respectively. While 20.6% were not exposed to any marker, 18.8% accumulated three or more dimensions. The risk of APO increased significantly with the cumulative number of vulnerabilities. Define and validate a vulnerability score could be useful to identify vulnerable women, adapt their pregnancy monitoring and help policy makers to implement appropriate education or health promotion programs.

Meeting the needs of pregnant women in socially vulnerable situations: A phenomenological qualitative study

“…As such, based on the French Health Authority's recommendations [ 17 ] and the Canadian study on indigenous women [ 30 ], we can confirm the importance of a single trusted contact person to optimise the coordination of prenatal care. Other international studies about the care of vulnerable pregnant women do not specifically recommend the place of this support person [ 16 , 20 , 21 , 23 , 26 ]. However, an analysis of the recommendation for having personalised care in proximity to the vulnerable pregnant woman's culture corresponds to our findings, ensuring a single trusted contact person.…”

“…Despite these plans, the international literature indicates there is room for improvement in the support and care of pregnant women in vulnerable situations. Professionals need to identify vulnerable pregnant women and facilitate their access to care [ 16 , 20 , 21 ]. Currently, there are quantitative epidemiological studies evaluating the effectiveness of perinatal measures [ [21] , [22] , [23] ].…”

“…Professionals need to identify vulnerable pregnant women and facilitate their access to care [ 16 , 20 , 21 ]. Currently, there are quantitative epidemiological studies evaluating the effectiveness of perinatal measures [ [21] , [22] , [23] ]. In addition, some studies have considered pregnant women's views of their maternity and follow-up experiences [ 24 , 25 ] or screenings conducted by GPs [ 1 ].…”

Association between moderated level of air pollution and fetal growth: the potential role of noise exposure

“…Environmental residential exposures. The residential exposure assessments have been previously described 10,[33][34][35][46][47][48][49][50] . The participants' addresses at the date of delivery were extracted from CPage software (ver-sion 2, https:// www.…”

Periconceptional maternal social, lifestyle and medical risk factors impair embryonic growth: The Rotterdam Periconceptional Cohort

“…Several studies have demonstrated that vulnerability markers predict the risk of adverse pregnancy outcomes (Brembilla, et al 2019, Posthumus, et al 2016. Brembilla, et al (2019) showed that vulnerability markers tend to accumulate, and are subsequently associated with an increased risk of adverse pregnancy outcomes (Brembilla, et al 2019).…”