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The role of neighbourhood socioeconomic status in large for gestational age.

ABSTRACT: OBJECTIVE:To determine whether neighbourhood socioeconomic status (SES) was associated with large for gestational age (LGA) while considering key sociodemographic and clinical confounding factors. SETTING AND PATIENT:All singleton infants whose parents were living in the city of Marseilles, France, between 2013 and 2016. METHOD:Population-based study based on new-born hospital birth admission charts from the French National Uniform Hospital Discharge Data Set Database. LGA infants were compared to appropriate-for-gestational-age (AGA) infants. Multiple generalized logistic model analysis was used to examine factors associated with LGA. RESULTS:A total of 43,309 singleton infants were included, and 4,747 (11%) were born LGA. LGA infants were more likely to have metabolic and respiratory diseases and to be admitted to the neonatal intensive care unit. Multiparity, advanced maternal age, obesity and diabetes were associated with an increased risk of LGA. Lower neighbourhood SES was associated with LGA (aOR = 1.24, 95% CI: 1.14; 1.36; p<0.0001) independent of age, diabetes, obesity, maternal smoking and multiparity. The strength of this association increased with maternal age, reaching an aOR of 1.50 (95% CI: 1.26; 1.78; p<0.0001) for women > 35 years old. CONCLUSION:Neighbourhood SES could be considered an important factor for clinicians to better identify mothers at risk of having LGA births in addition to well-known risk factors such as maternal diabetes, obesity and age. The intensification of the association between SES and LGA with increasing maternal age suggests that neighbourhood disadvantage may act on LGA cumulatively over time.

SUBMITTER: Boubred F

PROVIDER: S-EPMC7274403 | biostudies-literature | 2020

REPOSITORIES: biostudies-literature

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The role of neighbourhood socioeconomic status in large for gestational age.

Boubred Farid F Pauly Vanessa V Romain Fanny F Fond Guillaume G Boyer Laurent L

PloS one 20200605 6

<h4>Objective</h4>To determine whether neighbourhood socioeconomic status (SES) was associated with large for gestational age (LGA) while considering key sociodemographic and clinical confounding factors.<h4>Setting and patient</h4>All singleton infants whose parents were living in the city of Marseilles, France, between 2013 and 2016.<h4>Method</h4>Population-based study based on new-born hospital birth admission charts from the French National Uniform Hospital Discharge Data Set Database. LGA ...[more]

PMID: 32502147

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Project description:The developmental health of young children is highly influenced by the socioeconomic conditions in which they are raised. How to accurately measure these conditions is a point of debate in the current literature on child development, health, and social determinants. We have evaluated four existing indices of socioeconomic status (SES) to determine the most relevant for the analysis of early childhood development (ECD) in Canada. Following a literature review of published SES indices which used 2006 Canadian Census data, four indices were chosen based on their relevance to ECD and the number of citations in subsequent articles. These were: the Canadian Deprivation Index, the Socioeconomic Factor Index, the Canadian Marginalization Index and an index created by the Early Childhood Mapping Project in Alberta, Canada. The indices were replicated using SES data for 2038 customized geographic neighbourhoods encompassing 99.9% of the Canadian population, and the relationship of the indices to ECD was investigated by linking to aggregated data from the Early Development Instrument (EDI), a teacher-completed questionnaire used to assess kindergarten children's physical, social, emotional, and cognitive development, and communication skills. The derived SES indices were compared based on four criteria: the input variables used, the index structure, the interpretability of the index and the variance they explained (R2) in the different EDI outcome measures. In terms of variance explained, material components of the SES indices (e.g., income, education) consistently showed the strongest association with children's language and cognitive development. The patterns of association for the non-material SES components and the other developmental domains of the EDI were more complex. We discuss the findings in regard to current developments in the field, and the need for refining empirical and theoretical approaches to examine associations between different facets of SES contextual factors and different aspects of ECD outcomes.

Project description:BackgroundAdverse birth outcomes have serious health consequences, not only during infancy but throughout the entire life course. Most evidence linking neighbourhood socioeconomic status (SES) to birth outcomes is based on cross-sectional SES measures, which do not reflect neighbourhoods' dynamic nature. We investigated the association between neighbourhood SES trajectories and adverse birth outcomes, i.e. preterm birth and being small-for-gestational-age (SGA), for births occurring in the Netherlands between 2003 and 2017.MethodsWe linked individual-level data from the Dutch perinatal registry to the Netherlands Institute for Social Research neighbourhood SES scores. Based on changes in their SES across four-year periods, neighbourhoods were categorised into seven trajectories. To investigate the association between neighbourhood SES trajectories and birth outcomes we used adjusted multilevel logistic regression models.FindingsData on 2 334 036 singleton births were available for analysis. Women living in stable low-SES neighbourhoods had higher odds of preterm birth (OR[95%CI]= 1·12[1·07-1·17]) and SGA (OR[95%CI]= 1·19[1·15-1·23]), compared to those in high SES areas. Higher odds of preterm birth (OR[95%CI]= 1·12[1·05-1·20]) and SGA (OR[95%CI]=1·12[1·06-1·18]) were also observed for those living in areas declining to low SES. Women living in a neighbourhood where SES improved from low to medium showed higher odds of preterm birth (OR[95%CI]= 1·09[1·02-1·18]), but not of SGA (OR[95%CI]= 1·04[0.98-1·10]). The odds of preterm or SGA birth in other areas were comparable to those seen in high SES areas.InterpretationIn the Netherlands, disadvantaged neighbourhood SES trajectories were associated with higher odds of adverse birth outcomes. Longitudinal neighbourhood SES measures should also be taken into account when selecting a target population for public health interventions.FundingErasmus Initiative Smarter Choices for Better Health.

Project description:BACKGROUND:Of the many negative outcomes associated with gestational alcohol use, one that has received relatively little attention is preterm birth and its possible contribution to effects of prenatal alcohol exposure (PAE) on development. To examine the increased risk for premature delivery associated with PAE and the joint influence of preterm birth and alcohol on child outcomes, analysis was carried out in a longitudinal cohort recruited in Western Ukraine. METHODS:Alcohol-using women and low or nondrinking controls were identified prenatally for a clinical trial of multivitamins and minerals (MVM) in ameliorating effects of PAE. Women were interviewed to provide information about medical and social status and other drug use. At delivery, information was collected about infant (N?=?686) status including gestational age (GA) in weeks. Finally, 441 infants were followed to 6 months of age and cognitive (Mental Developmental Index [MDI]) and motor development (Psychomotor Developmental Index [PDI]) (measured using the Bayley Scales of Infant Development, second Ed (BSID-II). RESULTS:Seven percent infants were born at <37?weeks GA. The odds ratio for preterm delivery for Alcohol Exposed versus Low/No Alcohol was 2.6 (95% Confidence Interval 1.37, 4.94) (p?<?.003); MVM supplements were associated with a lower rate of preterm delivery overall, but the relative proportion of preterm births did not vary by MVM supplement status between alcohol exposure groups. In mediation models of 6 month cognitive and motor development with reference to Barron and Kenney in 1986, GA significantly mediated alcohol effects (MDI: Z?=?-2.64, p?<?.008; PDI: Z?=?-2.35, p?<?.02) although PAE independently affected both outcomes (MDI: t?=?-5.6, p?<?.000; PDI: t?=?-3.19, p?<?.002). CONCLUSION:Results suggest that PAE is associated with higher rates of preterm birth and that alcohol's effect on development in infancy may be both direct and mediated by shortened length of gestation.

Project description:ObjectivesEvidence about the relationship between socioeconomic status (SES) and small-for-gestational-age (SGA) infants was insufficient among Chinese primiparae. In addition, factors that may mediate this relationship are poorly understood. The purpose of this study was to investigate the risk of and mediators between SES and SGA.DesignRetrospective cohort study.SettingWuhan, Hubei, China.MethodParticipants were recruited from patients who gave birth in the maternity care hospital of Wuhan between September 2012 and October 2014. Logistic regression models were used to estimate the association between SES and SGA. Pathway analysis was performed to examine the contribution of maternal lifestyles and pregnancy-induced hypertension syndrome (PIH) to the relationship between SES and SGA. Total effect, direct effect and indirect effect of SES on SGA were measured. Effect sizes were evaluated by unstandardised estimates (B) and standardised estimates (ß).ResultsAmong 8737 primiparae, 927 (10.61%) pregnant women had babies with SGA. High SES was inversely associated with risk of SGA (OR 0.856; 95%?CI 0.737 to 0.995) after adjustment for potential confounders. Maternal obstetric characteristics, lifestyles and PIH completely mediated SES and SGA (indirect effect: B=-0.067, 95% CI -0.108 to -0.026). The indirect effect of SES was strengthened by PIH (B=-0.029), a multivitamin supplement (B=-0.021), prepregnancy body mass index (BMI) ?18.50 (B=-0.009) and prepregnancy BMI ?18.50?to gestational weight gain (GWG) not below the Institute of Medicine (IOM) recommendations (B=-0.003).ConclusionsWomen from high SES predicted lower risk of PIH, more chances to take a multivitamin supplement during early pregnancy, keeping prepregnancy BMI ?18.50?kg/cm2 and gaining adequate gestational weight which was not below IOM recommendations. Furthermore, lower risk of PIH, more chances to take a multivitamin supplement, prepregnancy BMI ?18.50?kg/cm2 and GWG not below IOM recommendations were associated with a lower risk of SGA infants.

Project description:OBJECTIVE:Low neighbourhood socioeconomic status (NSES) has been linked to a higher risk of overweight/obesity, irrespective of the individual's own socioeconomic status. No meta-analysis study has been done on the association. Thus, this study was done to synthesise the existing evidence on the association of NSES with overweight, obesity and body mass index (BMI). DESIGN:Systematic review and meta-analysis. DATA SOURCES:PubMed, Embase, Scopus, Cochrane Library, Web of Sciences and Google Scholar databases were searched for articles published until 25 September 2019. ELIGIBILITY CRITERIA:Epidemiological studies, both longitudinal and cross-sectional ones, which examined the link of NSES to overweight, obesity or BMI, were included. DATA EXTRACTION AND SYNTHESIS:Data extraction was done by two reviewers, working independently. The methodological quality of included studies was assessed using the Newcastle-Ottawa Scale for the observational studies. The summary estimates of the relationships of NSES with overweight, obesity and BMI statuses were calculated with random-effects meta-analysis models. Heterogeneity was assessed by Cochran's Q and I2 statistics. Subgroup analyses were done by age categories, continents, study designs and NSES measures. Publication bias was assessed by visual inspection of funnel plots and Egger's regression test. RESULT:A total of 21 observational studies, covering 1 244 438 individuals, were included in this meta-analysis. Low NSES, compared with high NSES, was found to be associated with a 31% higher odds of overweight (pooled OR 1.31, 95% CI 1.16 to 1.47, p<0.001), a 45% higher odds of obesity (pooled OR 1.45, 95% CI 1.21 to 1.74, p<0.001) and a 1.09 kg/m2 increase in mean BMI (pooled beta=1.09, 95% CI 0.67 to 1.50, p<0.001). CONCLUSION:NSES disparity might be contributing to the burden of overweight/obesity. Further studies are warranted, including whether addressing NSES disparity could reduce the risk of overweight/obesity. PROSPERO REGISTRATION NUMBER:CRD42017063889.

Project description:BACKGROUND: Infants born late preterm (34?+?0 to 36?+?6?weeks GA (gestational age)) are known to have higher neonatal morbidity than term (37?+?0 to 41?+?6?weeks GA) infants. There is emerging evidence that these risks may not be homogenous within the term cohort and may be higher in early term (37?+?0 to 38?+?6?weeks GA). These risks may also be affected by socioeconomic status, a risk factor for preterm birth. METHODS: A retrospective population based cohort of infants born at 34 to 41?weeks of GA was assembled; individual and area-level income was used to develop three socioeconomic (SES) groups. Neonatal morbidity was grouped into respiratory distress syndrome (RDS), other respiratory disorders, other complications of prematurity, admission to a Level II/III nursery and receipt of phototherapy. Regression models were constructed to examine the relationship of GA and SES to neonatal morbidity while controlling for other perinatal variables. RESULTS: The cohort contained 25 312 infants of whom 6.1% (n?=?1524) were born preterm and 32.4% (n?=?8203) were of low SES. Using 39/40?weeks GA as the reference group there was a decrease in neonatal morbidity at each week of gestation. The odds ratios remained significantly higher at 37?weeks for RDS or other respiratory disorders, and at 38?weeks for all other outcomes. SES had an independent effect, increasing morbidity with odds ratios ranging from 1.2-1.5 for all outcomes except for the RDS group, where it was not significant. CONCLUSIONS: The risks of morbidity fell throughout late preterm and early term gestation for both respiratory and non-respiratory morbidity. Low SES was associated with an independent increased risk. Recognition that the morbidities associated with prematurity continue into early term gestation and are further compounded by SES is important to develop strategies for improving care of early term infants, avoiding iatrogenic complications and prioritizing public health interventions.

Dataset Information

The role of neighbourhood socioeconomic status in large for gestational age.

Publications

The role of neighbourhood socioeconomic status in large for gestational age.

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