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Studies have found great inequality in pregnancy outcomes between British ethnic and socio-economic groups

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A national survey of over 1 million births at the United Kingdom National Health Service (NHS) from 2015 to 2017 LancetFound that there was great inequality in the outcome of pregnancy between British ethnic and socio-economic groups.

The findings focus on the risks and behaviors of individual women and prenatal care, and current national programs to make pregnancy safer are sufficient to improve the outcomes of babies born in the United Kingdom. It suggests that it is not. The authors work together with politicians, public health professionals, and health care providers to tackle racism and discrimination in order to reduce disparities in childbirth outcomes at the national level. He states that support and lifelong health need to be improved.

“Across the UK, the reality is that women’s socio-economic and ethnic backgrounds are still strongly associated with the potential for serious adverse effects on babies. These inequality still remain in a significant proportion of the UK. The negative effects of pregnancy, “said Dr. Jennifer Jardin, co-author of the Royal University of Obstetrics and Gynecology.

She continues. “Over the last few decades, efforts to close the gap in childbirth outcomes, primarily focused on improving maternity care and individual behavioral targets, have been unsuccessful. Birth outcomes only represent the health of pregnant women. It also reflects her health, although it is necessary to continue to encourage healthy behavior during pregnancy, but a lifetime cumulative of racial discrimination and social and economic inequality for the health of women and families. We also need public health professionals and politicians to strengthen our efforts to address the impact, and the community. ”

The NHS has set a goal of halving stillbirth and neonatal mortality and reducing preterm birth levels by 25% by 2025. Socio-economic deprivation and ethnic minority backgrounds are known risk factors for the adverse effects of pregnancy. However, little is known about the strength of these risk factors and the magnitude of their impact at the population level. In addition, the lack of information on how differences in pregnancy outcomes relate to women’s social conditions and pre-existing health conditions can hinder efforts to improve pregnancy outcomes and reduce inequality. I have.

For more information, the National Maternity and Perinatal Audit team analyzed birth records at NHS hospitals in the United Kingdom from April 1, 2015 to March 31, 2017, and stillbirth (fetal death after 24 weeks gestation). ) Quantified socio-economic and ethnic inequality. , Preterm birth (stillbirth 37 weeks ago), and UK fetal growth restriction (FGR).

Occurs when the team has the same pregnancy risk as 20% of women in the most disadvantaged areas, or women of white ethnic background, both with and without adjusted smoking status We calculated the percentage of adverse pregnancy outcomes that we would not have had, the Bodymass Index (BMI), and other risk factors for pregnancy. Socio-economic status was measured for each region using a multiple deprivation index that combined information on income, employment, education, housing, crime, and living environment.

In total, 1,155,981 women of singleton birth were included in the survey, of which 77% were white, 12% were South Asian, 5% were black, 2% were racial / ethnic mixed, and 4% were other races. / It was a race. Overall, 4,505 women experienced stillbirth (0.4%). [ranging from 0.3% in the least socioeconomically deprived group to 0.5% in the most deprived group]). Of the 1,151,476 newborn babies, 69,175 (6%) [4.9% to 7.2%]) 22,679 preterm births (2%) [1.2% to 2.2%]) I gave birth at FGR.

According to the analysis, 24% of stillbirths, 19% of preterm births and 31% of births with FGR were due to socio-economic inequality, and all women were at risk of adversely affecting pregnancy, at least as well as women. It is presumed that the case did not occur. The robbed group. Adjusting ethnicity, maternal smoking, and BMI significantly reduced these inequality (12%, 12%, and 16%, respectively), and these characteristics significantly reduced the socio-economic inequality of pregnancy outcomes. It suggests that we can explain the part of.

Pregnancy complications have disproportionately affected blacks and ethnic minority women. Ethnic inequality accounts for 12% of all stillbirths, 1% of preterm births, and 17% of births with FGR. Importantly, socio-economic deprivation, maternal smoking, and BMI adjustment had little effect on these associations. This indicates that other factors related to ethnic and cultural discrimination can exacerbate the outcome of pregnancy.

However, the greatest increase in stillbirth and FGR excess risk occurred in the most socio-economically disadvantaged South Asian and black women (Figure 3). For example, more than half of the stillbirths of the most disadvantaged South Asian women and three-quarters of births with FGR can be avoided because of socio-economic and ethnic inequality.

There are many possible reasons for these disparities. Poor areas and women of black and ethnic minorities can be disadvantaged due to environments such as pollution, poor housing, social isolation, restricted access to childbirth and medical care, precarious employment, poor working conditions and stress. There are sex events in life. The national goal for making pregnancy safer is when midwives, obstetricians, public health professionals, and politicians have coordinated efforts to address broader socio-economic and ethnic inequality. Will only be achieved. “

Professor Jan van der Meulen, co-author, London School of Economics and Tropical Medicine, UK

The authors propose three important steps to reduce inequality in pregnancy outcomes. Initial measures include improving access to quality prenatal care for high-risk groups with clinical interventions during pregnancy, such as smoking cessation and nutritional programs (for example, fetal). Monitor growth more accurately and frequently, increasing the risk of stillbirth). They also recommend public health strategies to reduce pre-pregnancy women’s health inequality, including smoking and eating habits, as well as stress associated with mental health problems, substance abuse and social disadvantages. It focuses on the broader side of adversity. Finally, the authors call for more comprehensive policies to address the root causes of inequality that indirectly affect pregnancy outcomes, such as income, education and employment.

The authors acknowledge that their findings show observational differences and note some methodological limitations. They used a measure of region-based socio-economic deprivation that may not accurately represent the extent of individual socio-economic status within a particular region. In addition, their findings assume that the effects of socio-economic deprivation and ethnicity are not altered by other circumstances such as overall health, lifestyle and nutrition.

In a linked comment, Dr. Catherine Grants of the National Institutes of Health (who was not involved in the study) said: Given the amount of evidence that racial and socio-economic disparities persist in perinatal and female health, upstream approaches to the systematic causes of inequality and discrimination target individuals. Actions that are more likely to help a country achieve its population goals than the downstream approaches traditionally adopted for it. “

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