Vol. 10 No. 2 (2018): Archives of Public Health
Clinical Science

Perinatal outcome in context of the social determinants of health

Elizabeta Zisovska
University Clinic for gynecology and obstetrics, Skopje, Republic of Macedonia

Published 2018-11-12

Keywords

  • newborn,
  • social determinant,
  • perinatal morbidity

How to Cite

1.
Zisovska E. Perinatal outcome in context of the social determinants of health. Arch Pub Health [Internet]. 2018 Nov. 12 [cited 2024 Mar. 28];10(2):71-8. Available from: https://www.id-press.eu/aph/article/view/2246

Abstract

The importance of recognition of the social determinants and the degree to which they influence the perinatal health is of utmost significance for the reproductive epidemiology and therefore they are important causes of the health inequalities within and between the countries.  These facts have implied the aims of this study, to evaluate four frequent social determinants (level of education, employment status, parity and antenatal controls) and their influence on the two adverse perinatal outcomes – preterm/near term newborn of 35-37 gestational weeks, and small for gestational age baby (SGA). The research is a part of very extensive study, and by design it was prospective cohort study during which validated Questionnaire was used and extracted data from the maternal and neonatal history. As very relevant, the statistical parameters Relative Risk and Numbers Needed to Treat (NNT) were used for risk analysis. The Results have shown strong influence of the maternal education on the both perinatal outcomes. The Relative risk for preterm delivery in 35-37th gestational week in mother of uneducated mother is 14,963 (95%CI 4,54-49,27) compared to mother of academic level of education; the relative risk for SAG newborn is 3,204 (95%CI 2,12-4,84); in unemployed mother, the relative risk for preterm delivery is 4,585 of that in mother of academic level (95%CI 2,27-9,28), whereas for SGA baby is 4,799 (95%CI 3,17-7,26). No antenatal control in pregnancy is high risk for bad outcome, but in this study the Relative risk for preterm delivery was 1,293 (95%CI 0,67-2,47), and for SGA babies it was very low compared to full control in pregnancy, and was 1,041 (95%CI 0,84-1,29).

According to these findings, it is obvious that the understanding of the social determinants of health priorities are the first and the most important step towards their gradual reduction, and this action is an entry point for global action to reach the health goals. Therefore, it is recommended such types of research studies to be conducted in extensive sample size, considering as much as possible social determinants, and performing multivariate analysis, in order to get higher statistical significance, which will help in creating strategies and activities for reduction of the most influential social determinants and improvement of the perinatal outcome of the newborns.

Downloads

Download data is not yet available.

References

  1. Министерство за труд и социјална политика на Република Македонија. Стратегија за демографски политики на Република Македонија 2015-2024 година. 2015 стр. 4, 16-20.
  2. Kadir A. Qualitative exploration of the social determinants of child health in the Dwars River Valley, South Africa: London School of Hygiene and Tropical Medicine. 2013.
  3. Министерство за здравство на Република Македонија. Подобрување на здравјето на мајките и доенчињата, Стратегија за безбедно мајчинство 2010-2015 година, октомври. 2010: 4-7
  4. Државен центар за репродуктивно здравје во Република Македонија. Перинатолошки резултати во Република Македонија 2017 година. Скопје; 2018: 8-10.
  5. Gluckman PD, Hanson MA, Cooper C, Thornburg KL. Effect of in utero and early-life conditions on adult health and disease. New England Journal of Medicine 2008; 359(1): 61-73.
  6. Godfrey KM, & Barker DJ. Fetal programming and adult health. Public Health Nutr 2001; 4(2B), 611-624.
  7. World Health Organization. Web site: http://www.who.int/maternal_child_adolescent/topics/maternal/maternal_perinatal/en/. Accessed 15.05.2018
  8. American Academy for Pediatrics, American College for Obstetrics and Gynecology. Guidelines for perinatal care. 2012; 7th Edition, ISBN 978-1-58110-734-0 (AAP)—ISBN 978-1-934984-17-8 (ACOG) American Academy of Pediatrics. II. American College of Obstetricians. US 2012
  9. World Health Organization. World Health Statistics. Monitoring health for the SDGs, Sustainable Development Goals. ISBN 978-92-4-156548-6. 2017.
  10. MacDorman MF, Kirmeyer S, Wilson EC. Fetal and perinatal mortality, United States,. Natl Vital Stat Rep 2012; 60(8):1-22.
  11. Spiegelman D, Hertzmark E. Easy SAS calculations for risk or prevalence ratios and differences. Am J Epidemiol 2005;162:199–200.
  12. Saunders M, Barr B, McHale P, Hamelmann C. Key policies for addressing the social determinants of health and health inequities. Copenhagen: WHO Regional Office for Europe; 2017.
  13. Aliyu MH, Luke S, Wilson RE, Saidu R, Alio AP, Salihu HM, Belogolovkin V. Obesity in older mothers, gestational weight gain, and risk estimates for preterm phenotypes. Maturitas 2010; 66(1): 88-93
  14. Bhutta ZA, Lassi ZS, Blanc A, Donnay F. Linkages among reproductive health, maternal health, and perinatal outcomes. Semin Perinatol 2010; 34(6):434-45.
  15. Kadir A, Marais F, Desmond N. Community perceptions of the social determinants of child health in Western Cape, South Africa: neglect as a major predictor of child health and wellness. Paediatrics And International Child Health 2013; 33(4): 310-321.
  16. Nordstrom ML, Cnattingius S. Effects on birth weights of maternal education, socioeconomic status, and work related characteristics. Scand J Public Health 1996; 24(1):55–61.
  17. Cantarutti A, Franchi M, Compagnoni MM, Merlino L, Corrao G. Mother's education and the risk of several neonatal outcomes: An evidence from an Italian population-based study. BMC Pregnancy and Childbirth 2017;17(1):221
  18. Joffre M: Social inequalities in low birth weight: Timing of effects and selective mobility. Soc Sci Med 1989, 28(6):613–19.
  19. Nair M, Webster P, Ariana P. Impact of non-health policies on infant mortality through the social determinants pathway. Bull WHO 2011; 89 (778).
  20. Bhutta ZA, Cabral S, Chan CW, Keenan WJ. Reducing maternal, newborn, and infant mortality globally: An integrated action agenda. International Journal of Gynecology and Obstetrics 2012; 119 (Suppl 1): S13-17.
  21. Shah PS, Zao J, Ali S. Maternal marital status and birth outcomes: A systematic review and meta-analyses. Matern Child Health J 2011;15(7):1097-109.
  22. Tennant PWG, Rankin J, Bell R. Maternal body mass index and the risk of fetal and infant death: A cohort study from the North of England. Hum. Reprod 2011; 26: 1501–1511.
  23. Wallace ME, Harville EW. Predictors of healthy birth outcome in adolescents: a positive deviance approach. J Pediatr Adolesc Gynecol 2012; 25(5):314-21.
  24. Dubowitz L, Ricciw D, Mercuri E. The Dubowitz neurological examination of the full-term newborn. Ment Retard Dev Disabil Res Rev 2005; 11:52.
  25. Lee AC, Panchal P, Folger L, et al. Diagnostic accuracy of neonatal assessment for gestational age determination: A systematic review. Pediatrics 2017; 140.
  26. Chen L, Xiao L, Auger N, et al. Disparities and trends in birth outcomes, perinatal and infant mortality in aboriginal vs. non-aboriginal populations: A population-based Study in Quebec, Canada 1996–2010. Chen A, ed. PLoS ONE. 2015;10(9):e0138562.
  27. Egerter S, Braveman P, Sadegh-Nobari T, Grossman-Kahn R, Dekker M. Education and Health. Publisher: Robert Wood Johnson Foundation; 2011.
  28. Savitz DA, Olshan, AF. and Gallagher, K. Maternal Occupation and Pregnancy Outcome. Epidemiology 1996; 7 (3): 269-274.
  29. Usynina AA, Grjibovski AM, Odland JØ, Krettek A. Social correlates of term small for gestational age babies in a Russian Arctic setting. Int J Circumpolar Health 2016; 29:75.