Socio-demographic inequalities across a range of health status indicators and health behaviours among pregnant women in prenatal primary care: a cross-sectional study

Abstract

BackgroundSuboptimal maternal health conditions (such as obesity, underweight, depression and stress) and health behaviours (such as smoking, alcohol consumption and unhealthy nutrition) during pregnancy have been associated with negative pregnancy outcomes. Our first aim was to give an overview of the self-reported health status and health behaviours of pregnant women under midwife-led primary care in the Netherlands. Our second aim was to identify potential differences in these health status indicators and behaviours according to educational level (as a proxy for socio-economic status) and ethnicity (as a proxy for immigration status).MethodsOur cross-sectional study (data obtained from the DELIVER multicentre prospective cohort study conducted from September 2009 to March 2011) was based on questionnaires about maternal health and prenatal care, which were completed by 6711 pregnant women. The relationships of education and ethnicity with 13 health status indicators and 10 health behaviours during pregnancy were examined using multilevel multiple logistic regression analyses, adjusted for age, parity, number of weeks pregnant and either education or ethnicity.ResultsLower educated women were especially more likely to smoke (Odds Ratio (OR) 11.3; 95 % confidence interval (CI) 7.6– 16.8); have passive smoking exposure (OR 6.9; 95 % CI 4.4–11.0); have low health control beliefs (OR 10.4; 95 % CI 8.5–12.8); not attend antenatal classes (OR 4.5; 95 % CI 3.5–5.8) and not take folic acid supplementation (OR 3.4; 95 % CI 2.7–4.4). They were also somewhat more likely to skip breakfast daily, be obese, underweight and depressed or anxious. Non-western women were especially more likely not to take folic acid supplementation (OR 4.5; 95 % CI 3.5–5.7); have low health control beliefs (OR 4.1; 95 % CI 3.1–5.2) and not to attend antenatal classes (OR 3.3; 95 % CI 2.0–5.4). They were also somewhat more likely to have nausea, back pains and passive smoking exposure.ConclusionsSubstantial socio-demographic inequalities persist with respect to many health-related issues in medically low risk pregnancies in the Netherlands. Improved strategies are needed to address the specific needs of socio-demographic groups at higher risk and the structures underlying social inequalities in pregnant women.

Characteristics of health behaviours and health status indicators among pregnant women in Slovenia

“…Our findings are in line with previous studies, which reported that smoking, including passive smoking, was the health behaviour most strongly associated with educational disparities, finding a higher percentage of smokers in groups of pregnant women with lower levels of education (19,23,24). Study Lu Y et al (2001) also reported that smokers with higher levels of education were more likely to stop smoking when they discovered they were pregnant, leading to even greater disparities in smoking (19,25). According to a cross--sectional study of pregnant women and new mothers from 15 European countries, which also included data from Slovenia, prevalence of smoking during pregnancy ranged from 18.9 % in Croatia to 4.2 % in Iceland (9).…”

“…The correlation between lower maternal education and lower maternal age is expected because women increasingly delay childbirth in order to receive more education and take advantage of increased career opportunities created thereby (22). Our findings are in line with previous studies, which reported that smoking, including passive smoking, was the health behaviour most strongly associated with educational disparities, finding a higher percentage of smokers in groups of pregnant women with lower levels of education (19,23,24). Study Lu Y et al (2001) also reported that smokers with higher levels of education were more likely to stop smoking when they discovered they were pregnant, leading to even greater disparities in smoking (19,25).…”

“…Our findings are in line with numerous studies that reported higher prevalence of folate and multivitamin supplementation among women with higher levels of education (5,44,45,46), nulliparous women (47) and among women who were older at conception (47). Higher maternal education is associated with higher health literacy, health control beliefs and risk adverse behaviour, which corresponds to periconceptional supplementation (9,19,48). The study by Baron et al (2015) reported sizable disparities in unbeneficial health status and behaviours according to educational level, in that women with lower education have low health control beliefs, higher incidences of both obesity and being underweight, higher incidence of depression/anxiety, higher incidence of smoking and passive smoking exposure, lower antenatal attendance, lower folic acid supplementation, higher incidence of skipping breakfast daily and unplanned pregnancies and lower incidence of daily fruit consumption (19).…”

“…This increasing pressure has resulted in hyper-vigilant pregnant women going out of their way to avoid any possible toxins, while also adopting unhealthy behaviours, such as smoking and excessive eating in response to the stress of "intensive motherhood" (2,19). A recent Slovenian study reported that the same dilemmas continue during postpartum period, showing that breastfeeding mothers used less medications and nutritional supplements compared to non-breastfeeding mothers (20).…”

Astrofood, Priorities and Pandemics: Reflections of an Ultra-Processed Breakfast Program and Contemporary Dysbiotic Drift

“…Moreover, in a 2017 breakfast study, researchers reported that a high-fat/high sugar "toasted sandwich" and chocolate milk-type beverage caused reductions in hippocampal-dependent learning and memory in healthy young adults after only four days [61]. Skipping breakfast has also been linked to depression, anxiety and high levels of stress throughout the life course, and this is pronounced in association with socioeconomic disadvantage [62][63][64].…”