Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2011 Jul 19:343:d4306.
doi: 10.1136/bmj.d4306.

Socioeconomic inequalities in outcome of pregnancy and neonatal mortality associated with congenital anomalies: population based study

Lucy K Smith  1 , Judith L S Budd, David J Field, Elizabeth S Draper
Affiliations

Socioeconomic inequalities in outcome of pregnancy and neonatal mortality associated with congenital anomalies: population based study

Lucy K Smith et al. BMJ. .

Abstract

Objectives: To investigate socioeconomic inequalities in outcome of pregnancy and neonatal mortality associated with congenital anomalies.

Design: Retrospective population based registry study.

Setting: East Midlands and South Yorkshire regions of England (representing about 10% of births in England and Wales).

Participants: All registered cases of nine selected congenital anomalies with poor prognostic outcome audited as part of the United Kingdom's fetal anomaly screening programme with an end of pregnancy date between 1 January 1998 and 31 December 2007.

Main outcome measures: Socioeconomic variation in the risk of selected congenital anomalies; outcome of pregnancy; incidence of live birth and neonatal mortality over time. Deprivation measured with the index of multiple deprivation 2004 at super output area level.

Results: There were 1579 fetuses registered with one of the nine selected congenital anomalies. There was no evidence of variation in the overall risk of these anomalies with deprivation (rate ratio for the most deprived 10th with the least deprived 10th: 1.05, 95% confidence interval 0.89 to 1.23). The rate ratio varied with type of anomaly and maternal age (deprivation rate ratio adjusted for maternal age: 1.43 (1.17 to 1.74) for non-chromosomal anomalies; 0.85 (0.63 to 1.15) for chromosomal anomalies). Of the nine anomalies, 86% were detected in the antenatal period, and there was no evidence that this varied with deprivation (rate ratio 0.99, 0.84 to 1.17). The rate of termination after antenatal diagnosis of a congenital anomaly was lower in the most deprived areas compared with the least deprived areas (63% v 79%; rate ratio 0.80, 0.65 to 0.97). Consequently there were significant socioeconomic inequalities in the rate of live birth and neonatal mortality associated with the presence of any of these nine anomalies. Compared with the least deprived areas, the most deprived areas had a 61% higher rate of live births (1.61, 1.21 to 2.15) and a 98% higher neonatal mortality rate (1.98, 1.20 to 3.27) associated with a congenital anomaly.

Conclusions: Antenatal screening for congenital anomalies has reduced neonatal mortality through termination of pregnancy. Socioeconomic variation in decisions regarding termination of pregnancy after antenatal detection, however, has resulted in wide socioeconomic inequalities in liveborn infants with a congenital anomaly and subsequent neonatal mortality.

PubMed Disclaimer

Conflict of interest statement

Competing interests: All authors have completed the ICMJE uniform disclosure form at www.icmje.org/coi_disclosure.pdf (available on request from the corresponding author) and declare: no support from any organisation for the submitted work; no financial relationships with any organisations that might have an interest in the submitted work in the previous three years; no other relationships or activities that could appear to have influenced the submitted work.

References

    1. Oakley L, Maconochie N, Doyle P, Dattani N, Moser K. Multivariate analysis of infant death in England and Wales in 2005-06, with focus on socio-economic status and deprivation. Health Stat Q 2009;42:22-39. - PubMed
    1. Smith LK, Manktelow BN, Draper ES, Springett A, Field DJ. An investigation of the nature of socioeconomic inequalities in neonatal mortality: a population based study. BMJ 2010;341:c6654. - PMC - PubMed
    1. Neasham D, Dolk H, Vrijheid M, Jensen T, Best N. Stillbirth and neonatal mortality due to congenital anomalies: temporal trends and variation by small area deprivation scores in England and Wales, 1986-96. Paediatr Perinat Epidemiol 2001;15:364-73. - PubMed
    1. Olesen C, Thrane N, Ronholt AM, Olsen J, Henriksen TB. Association between social position and congenital anomalies: a population-based study among 19,874 Danish women. Scand J Public Health 2009;37:246-51. - PubMed
    1. Vrijheid M, Dolk H, Stone D, Abramsky L, Alberman E, Scott JE. Socioeconomic inequalities in risk of congenital anomaly. Arch Dis Child 2000;82:349-52. - PMC - PubMed

Publication types