Perinatal outcome in context of the social determinants of health
- social determinant,
- perinatal morbidity
How to Cite
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.
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