Adverse pregnancy outcomes attributable to socioeconomic and ethnic inequalities in England: a national cohort study


Background Socioeconomic deprivation and an ethnic minority background are known risk factors for adverse pregnancy outcomes. We quantified the magnitude of these socioeconomic and ethnic inequalities at population level in England. Methods We evaluated stillbirth, preterm birth (< 37 weeks gestation), and fetal growth restriction (FGR; liveborn with birthweight <3rd centile) in England between 1st April 2015 and 31st March 2017 by socioeconomic deprivation quintiles and ethnic group. Attributable fractions (AF) for the entire population and specific groups compared to least deprived and/or White women were calculated without and with adjustment for smoking and body mass index (BMI). Findings 1 155 981 women with a singleton birth were included. 4 494 births were stillbirths (0·4%). Of the 1 151 487 liveborn babies, 71 398 (6·2%) were preterm births and 23 526 (2·0%) births with FGR. 24% of stillbirths, 19% of preterm births, and 31% of FGR could be attributed to socioeconomic inequality. These population AFs were substantially reduced with adjustment for ethnic group, smoking and BMI (8%, 13% and 19%, respectively). 12% of stillbirths, 1% of preterm births and 17% of FGR could be attributed to ethnic inequality. Adjustment for socioeconomic deprivation, smoking and BMI only had a small impact on these ethnic group AFs (13%, 3% and 19%, respectively). Group-specific AFs were especially high in the most socioeconomically deprived South-Asian women and Black women for stillbirth (54% and 64%, respectively) and FGR (72% and 55%, respectively). Interpretation Socioeconomic inequalities account for a quarter of stillbirths, a fifth of preterm births, and a third of births with FGR. The largest inequalities were seen in the most deprived Black and South-Asian women. Prevention should target the entire population as well as particular high-risk ethnic minority groups, addressing specific risk factors and the wider determinants of health.


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stillbirth, preterm birth, fetal growth restriction, inequality, socioeconomic deprivation, ethnicity


Jardine, J., Walker, K., Gurol-Urganci, I., Webster, K., Muller, Patrick., Hawdon, J., Khalil, A., Harris, T., van der Meulen, J. (2021) Adverse pregnancy outcomes attributable to socioeconomic and ethnic inequalities in England: a national cohort study. The Lancet, 398 (10314), pp. 1905-1912


Research Institute

Centre for Reproduction Research (CRR)