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

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. However, there is a lack of evidence on the strength of these risk factors and on the scale of their impact. Aims/objectives We quantified the magnitude of adverse pregnancy outcomes attributable to socioeconomic and ethnic inequalities at population level in England Methods (including research design, sample, analysis and ethical approval) We used administrative hospital data to evaluate stillbirth (SB), preterm birth (PTB) and fetal growth restriction (FGR) in England between 1/4/15-31/3/17 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). This study was exempt from ethical review as we used routinely collected data; personal data used without individual consent was approved by the NHS Health Research Authority.

Findings 1 155 981 women with a singleton birth were included. There were 4505 stillbirths (0·4%). Of liveborn babies, 69175 (6·0%) were PTBs and 22 679 (2·0%) births with FGR. 24% of SBs, 19% of PTBs, and 31% of FGR could be attributed to socioeconomic inequality. These population AFs were substantially reduced with adjustment for ethnic group, smoking and BMI (12%, 10% and 17%, respectively). 12% of SBs, 1.2% of PTBs and 17% of FGR could be attributed to ethnic inequality. Adjustment for socioeconomic deprivation, smoking and BMI had only a small impact on these ethnic group AFs (13%, 2.6% and 19%, respectively). Group-specific AFs were especially high in the most socioeconomically deprived South-Asian women and Black women for SB (54% and 64%, respectively) and FGR (72% and 55%, respectively). Conclusions. Reducing FGR, SB and PTB rates can only realistically be achieved with midwives, obstetricians, public health professionals and politicians working together to reduce such inequalities in outcome for the most vulnerable.