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
Multicenter Study
. 2017 May 16;17(1):126.
doi: 10.1186/s12884-017-1310-z.

Association between maternal social deprivation and prenatal care utilization: the PreCARE cohort study

Clémentine Gonthier  1   2 , Candice Estellat  3   4 , Catherine Deneux-Tharaux  1 , Béatrice Blondel  1 , Toni Alfaiate  3 , Thomas Schmitz  5 , Jean-François Oury  5 , Laurent Mandelbrot  6 , Dominique Luton  2   7 , Philippe Ravaud  8 , Elie Azria  9   10
Affiliations
Multicenter Study

Association between maternal social deprivation and prenatal care utilization: the PreCARE cohort study

Clémentine Gonthier et al. BMC Pregnancy Childbirth. .

Abstract

Background: Maternal social deprivation is associated with an increased risk of adverse maternal and perinatal outcomes. Inadequate prenatal care utilization (PCU) is likely to be an important intermediate factor. The health care system in France provides essential health services to all pregnant women irrespective of their socioeconomic status. Our aim was to assess the association between maternal social deprivation and PCU.

Methods: The analysis was performed in the database of the multicenter prospective PreCARE cohort study. The population source consisted in all parturient women registered for delivery in 4 university hospital maternity units, Paris, France, from October 2010 to November 2011 (N = 10,419). This analysis selected women with singleton pregnancies that ended after 22 weeks of gestation (N = 9770). The associations between maternal deprivation (four variables first considered separately and then combined as a social deprivation index: social isolation, poor or insecure housing conditions, no work-related household income, and absence of standard health insurance) and inadequate PCU were tested through multivariate logistic regressions also adjusted for immigration characteristics and education level.

Results: Attendance at prenatal care was poor for 23.3% of the study population. Crude relative risks and confidence intervals for inadequate PCU were 1.6 [1.5-1.8], 2.3 [2.1-2.6], and 3.1 [2.8-3.4], for women with a deprivation index of 1, 2, and 3, respectively, compared to women with deprivation index of 0. Each of the four deprivation variables was significantly associated with an increased risk of inadequate PCU. Because of the interaction observed between inadequate PCU and mother's country of birth, we stratified for the latter before the multivariate analysis. After adjustment for the potential confounders, this social gradient remained for women born in France and North Africa. The prevalence of inadequate PCU among women born in sub-Saharan Africa was 34.7%; the social gradient in this group was attenuated and no longer significant. Other factors independently associated with inadequate PCU were maternal age, recent immigration, and unplanned or unwanted pregnancy.

Conclusion: Social deprivation is independently associated with an increased risk of inadequate PCU. Recognition of risk factors is an important step in identifying barriers to PCU and developing measures to overcome them.

Keywords: High-risk pregnancy; Prenatal care utilization; Social deprivation; Social inequalities in health.

PubMed Disclaimer

Figures

Fig. 1
Fig. 1
Inadequate PCU and social deprivation according to the woman’s region of birth. PCU: prenatal care utilization; DI: deprivation index: simple sum of 4 deprivation dimensions: Social isolation, Poor or insecure housing condition, Not work-related household income, and No permanent health care insurance
See this image and copyright information in PMC

References

    1. Cantwell R, Clutton-Brock T, Cooper G, Dawson A, Drife J, Garrod D, et al. Saving mothers’ lives: reviewing maternal deaths to make motherhood safer: 2006–2008. The eighth report of the confidential enquiries into maternal deaths in the United Kingdom. BJOG. 2011;118(Suppl 1):1–203. - PubMed
    1. Daoud N, O’Campo P, Minh A, Urquia ML, Dzakpasu S, Heaman M, et al. Patterns of social inequalities across pregnancy and birth outcomes: a comparison of individual and neighborhood socioeconomic measures. BMC Pregnancy Childbirth. 2015;14:393. doi: 10.1186/s12884-014-0393-z. - DOI - PMC - 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. doi: 10.1136/adc.82.5.349. - DOI - PMC - PubMed
    1. Blumenshine P, Egerter S, Barclay CJ, Cubbin C, Braveman PA. Socioeconomic disparities in adverse birth outcomes: a systematic review. Am J Prev Med. 2010;39:263–72. doi: 10.1016/j.amepre.2010.05.012. - DOI - PubMed
    1. Villar J, Ba’aqeel H, Piaggio G, Lumbiganon P, Belizán JM, Farnot U, et al. WHO antenatal care randomised trial for the evaluation of a new model of routine antenatal care. Lancet. 2001;357:1551–64. doi: 10.1016/S0140-6736(00)04722-X. - DOI - PubMed

Publication types