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Meta-Analysis
. 2021 Mar 15;11(3):e042753.
doi: 10.1136/bmjopen-2020-042753.

Socioeconomic inequalities and adverse pregnancy outcomes in the UK and Republic of Ireland: a systematic review and meta-analysis

Katie Thomson  1 , Malcolm Moffat  1 , Oluwatomi Arisa  1 , Amrita Jesurasa  2 , Catherine Richmond  1 , Adefisayo Odeniyi  1 , Clare Bambra  1   3 , Judith Rankin  1   3 , Heather Brown  1   3 , Julie Bishop  4 , Susan Wing  4 , Amy McNaughton  4 , Nicola Heslehurst  5   3
Affiliations
Meta-Analysis

Socioeconomic inequalities and adverse pregnancy outcomes in the UK and Republic of Ireland: a systematic review and meta-analysis

Katie Thomson et al. BMJ Open. .

Abstract

Objective: There has been an unprecedented rise in infant mortality associated with deprivation in recent years in the United Kingdom (UK) and Republic of Ireland. A healthy pregnancy can have significant impacts on the life chances of children. The objective of this review was to understand the association between individual-level and household-level measures of socioeconomic status and adverse pregnancy outcomes.

Design: Systematic review and meta-analysis.

Data sources: Nine databases were searched (Medline, Embase, Scopus, ASSIA, CINAHL, PsycINFO, BNI, MIDRIS and Google Scholar) for articles published between 1999 and August 2019. Grey literature searches were also assessed.

Study selection criteria: Studies reporting associations between individual-level or household socioeconomic factors on pregnancy outcomes in the UK or Ireland.

Results: Among the 82 353 search results, 53 821 titles were identified and 35 unique studies met the eligibility criteria. Outcomes reported were neonatal, perinatal and maternal mortality, preterm birth, birth weight and mode of delivery. Pooled effect sizes were calculated using random-effects meta-analysis. There were significantly increased odds of women from lower levels of occupation/social classes compared with the highest level having stillbirth (OR 1.40, 95% CI 1.23 to 1.59, I298.62%), neonatal mortality (OR 1.39, 95% CI 1.22 to 1.57, I297.09%), perinatal mortality (OR 1.39, 95% CI 1.23 to 1.57, I298.69%), preterm birth (OR 1.41, 95% CI 1.33 to 1.50, I270.97%) and low birth weight (OR 1.40, 95% CI 1.19 to 1.61, I299.85%). Limitations relate to available data, unmeasured confounders and the small number of studies for some outcomes.

Conclusions: This review identified consistent evidence that lower occupational status, especially manual occupations and unemployment, were significantly associated with increased risk of multiple adverse pregnancy outcomes. Strategies to improve pregnancy outcomes should incorporate approaches that address wider determinants of health to provide women and families with the best chances of having a healthy pregnancy and baby and to decrease pregnancy-related health inequalities in the general population.

Prospero registration number: PROSPERO CRD42019140893.

Keywords: epidemiology; fetal medicine; maternal medicine; public health.

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Conflict of interest statement

Competing interests: All authors have completed the ICMJE uniform disclosure form at www.icmje.org/coi_disclosure.pdf and declare: support from Public Health Wales for the submitted work; AJ, SW, JB and AM are all employees of Public Health Wales.

Figures

Figure 1
Figure 1
PRISMA flow chart. PRISMA, Preferred Reporting Items for Systematic Reviews and Meta-Analyses.
Figure 2
Figure 2
Forest plot of stillbirth. REML, Restricted Maximum Likelihood
Figure 3
Figure 3
Forest plot of perinatal mortality.
Figure 4
Figure 4
Forest plot of neonatal mortality.
Figure 5
Figure 5
Forest plot of VLBW.
Figure 6
Figure 6
Forest plot of LBW.
Figure 7
Figure 7
Forest plot of macrosomia.
Figure 8
Figure 8
Forest plot for preterm birth (<37 weeks gestation).
Figure 9
Figure 9
Forest plot of emergency caesarean section.
Figure 10
Figure 10
Forest plot of elective caesarean section.
Figure 11
Figure 11
Forest plot of any caesarean section.
See this image and copyright information in PMC

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