Keywords
Preterm birth
Individual Social deprivation
EPICES score
Abstract
Introduction: French national health programmes take into account social deprivation in their implementation, those targeting perinatal outcomes, especially. The main aim of the present work was to assess the association between individual social deprivation and adverse perinatal outcomes.
Methods: A multicentre cross-sectional population-based survey was performed between October and December 2007. Eligible women delivered a baby in one of the three maternity hospitals of Clermont-Ferrand area, and read and spoke French fluently. Women who had undergone voluntary termination of pregnancy were excluded. Individual social deprivation was measured by the EPICES score. Standard prenatal follow-up defined by having less than 7 consultations and quality of prenatal care defined by having at least four consultations were measured. Adverse perinatal outcomes were measured by a composite criterion defined by women who had the occurrence of the three main causes of pregnancy-related disorders: preterm delivery, and/or diabetes, and/or obstetrical hypertension.
Results: Of the 471 eligible women, 464 were finally included. One hundred and fifteen (24.78%) women were socially deprived. The most deprived women had poor standard prenatal follow-up (p=0.003) and poor quality of prenatal care (0.03). Nationality was the sole confounding factor identified. Deprived women had a two-fold greater risk of adverse perinatal outcomes, adjusted odds ratio 1.95 [1.15; 3.29].
Discussion: Social deprivation was associated with adverse perinatal outcomes. Social deprivation should be systematically screened in pregnant women standard follow-up, among migrant women, especially.
References
Wrezinski J. Grande pauvreté et précarité économique et sociale. Rapport présenté au nom du Conseil Economique et Social, Journal officiel, avis et rapports du Conseil Économique et Social. 1987
Townsend P. Deprivation. Jnl Soc Pol 1987;16(02):125. Available from: http://www.journals.cambridge.org/abstract_S0047279400020341 doi: 10.1017/S0047279400020341. [Google Scholar]
Gray AM. Inequalities in health. The Black Report: a summary and comment.. Int J Health Serv 1982;12(3):349-380. Available from: http://baywood.metapress.com/openurl.asp?genre=article&id=doi:10.2190/XXMM-JMQU-2A7Y-HX1E PubMed PMID: 7118327. doi: 10.2190/XXMM-JMQU-2A7Y-HX1E. [Google Scholar]
Carstairs V, Morris R. Deprivation: explaining differences in mortality between Scotland and England and Wales. BMJ 1989 Oct;299(6704):886-889. Available from: http://europepmc.org/abstract/MED/2510878 PubMed PMID: 2510878. doi: 10.1136/bmj.299.6704.886. [Google Scholar]
HCSP , author. Rapport: La santé en France 1994-1998. Available at: www.hcsp.fr/Explore.cgi/Telecharger?NomFichier=hc001035.pdf.
HCSP , author. Rapport: La progression de la précarité en France et ses effets sur la santé. Available at: www.hcsp.fr/Explore.cgi/Telecharger?NomFichier=hc001043.pdf.
Goyal D, Gay C, Lee KA. How much does low socioeconomic status increase the risk of prenatal and postpartum depressive symptoms in first-time mothers?. Womens Health Issues 2010;20(2):96-104. Available from: http://europepmc.org/abstract/MED/20133153 PubMed PMID: 20133153. doi: 10.1016/j.whi.2009.11.003. [Google Scholar]
Smith LK, Manktelow BN, Draper ES, Springett A, Field DJ. Nature of socioeconomic inequalities in neonatal mortality: population based study.. BMJ 2010 Dec;341. Available from: http://www.bmj.com/cgi/pmidlookup?view=long&pmid=21127118 PubMed PMID: 21127118. [Google Scholar]
Calling S, Li X, Sundquist J, Sundquist K. Socioeconomic inequalities and infant mortality of 46,470 preterm infants born in Sweden between 1992 and 2006.. Paediatr Perinat Epidemiol 2011 Apr;25(4):357-365. Available from: http://doi.wiley.com/10.1111/j.1365-3016.2011.01200.x PubMed PMID: 21649678. doi: 10.1111/j.1365-3016.2011.01200.x. [Google Scholar]
Taylor-Robinson D, Agarwal U, Diggle PJ, Platt MJ, Yoxall B, Alfirevic Z. Quantifying the impact of deprivation on preterm births: a retrospective cohort study. . Available from: http://www.ncbi.nlm.nih.gov/pubmed/21826237 PubMed PMID: 21826237. doi: 10.1371/journal.pone.0023163. [Google Scholar]
Reeske A, Kutschmann M, Razum O, Spallek J. Stillbirth differences according to regions of origin: an analysis of the German perinatal database, 2004-2007. BMC Pregnancy Childbirth 2011;11(1):63. Available from: http://bmcpregnancychildbirth.biomedcentral.com/articles/10.1186/1471-2393-11-63 PubMed PMID: 21936931. doi: 10.1186/1471-2393-11-63. [Google Scholar]
Auger N, Park AL, Gamache P, Pampalon R, Daniel M. Weighing the contributions of material and social area deprivation to preterm birth. Soc Sci Med 2012;75(6):1032-1037. Available from: http://linkinghub.elsevier.com/retrieve/pii/S0277953612004017 PubMed PMID: 22698926. doi: 10.1016/j.socscimed.2012.04.033. [Google Scholar]
Bonet M, Smith LK, Pilkington H, Draper ES, Zeitlin J. Neighbourhood deprivation and very preterm birth in an English and French cohort. BMC Pregnancy Childbirth 2013;13(1):97. Available from: http://www.biomedcentral.com/1471-2393/13/97 doi: 10.1186/1471-2393-13-97. [Google Scholar]
Wood S, McNeil D, Yee W, Siever J, Rose S. Neighbourhood socio-economic status and spontaneous premature birth in Alberta. . Available from: http://www.ncbi.nlm.nih.gov/pubmed/25365274 PubMed PMID: 25365274. [Google Scholar]
Poeran J, Maas AFG, Birnie E, Denktas S, Steegers EAP, Bonsel GJ. Social deprivation and adverse perinatal outcomes among Western and non-Western pregnant women in a Dutch urban population. Social Science & Medicine 2013;83:42-49. Available from: http://linkinghub.elsevier.com/retrieve/pii/S0277953613000816 doi: 10.1016/j.socscimed.2013.02.008. [Google Scholar]
Vos AA, Posthumus AG, Bonsel GJ, Steegers EAP, Denktaş S. Deprived neighborhoods and adverse perinatal outcome: a systematic review and meta-analysis. Acta Obstet Gynecol Scand 2014 Jun;93(8):727-740. Available from: http://doi.wiley.com/10.1111/aogs.12430 PubMed PMID: 24834960. doi: 10.1111/aogs.12430. [Google Scholar]
Pampalon R, Raymond G. A deprivation index for health and welfare planning in Quebec.. Chronic Dis Can 2000;21(3):104-113. PubMed PMID: 11082346. [Google Scholar]
Paugam S, Parizot I, Chauvin P. Les mégapoles face au défi des nouvelles inégalités. Paris: Flammarion; 2002. [Google Scholar]
Sass C, Guéguen R, Moulin JJ, Abric L, Dauphinot V, Dupré C, et al. [Comparison of the individual deprivation index of the French Health Examination Centres and the administrative definition of deprivation].. Sante Publique 2006;18(4):513-522. Available from: http://www.cairn.info/revue-sante-publique-2006-4-page-513.htm PubMed PMID: 17294755. doi: 10.3917/spub.064.0513. [Google Scholar]
Gayral-Taminh M, Daubisse-Marliac L, Baron M, Maurel G, Rème J, Grandjean H. [Social and demographic characteristics and perinatal risks for highly deprived mothers].. J Gynecol Obstet Biol Reprod (Paris) 2005;34(1 Pt 1):23-32. Available from: http://www.masson.fr/masson/S0368-2315(05)82667-5 PubMed PMID: 15767914. doi: 10.1016/S0368-2315(05)82667-5. [Google Scholar]
DREES. Surveillance de la grossesse en 2010: des inégalités socio-démographiques, N°848 juillet 2013.
Convers M, Langeron A, Sass C, Moulin J, Augier A, Varlet M, et al. [Is the socioeconomic deprivation EPICES score useful in obstetrics?].. Gynecol Obstet Fertil 2012;40(4):208-212. Available from: https://www.nlm.nih.gov/medlineplus/healthdisparities.html PubMed PMID: 22154671. doi: 10.1016/j.gyobfe.2011.10.014. [Google Scholar]
Labbe E, Blanquet M, Gerbaud L, Poirier G, Sass C, Vendittelli F, et al. A new reliable index to measure individual deprivation: the EPICES score. Eur J Public Health 2015 Jan;25(4):604-609. Available from: http://eurpub.oxfordjournals.org/lookup/doi/10.1093/eurpub/cku231 PubMed PMID: 25624273. doi: 10.1093/eurpub/cku231. [Google Scholar]
Nahon S, Lahmek P, Macaigne G, et al. Socioeconomic deprivation does not influence the severity of Crohn's disease: results of a prospective multicenter study. Inflamm Bowel Dis 2009;15(4):594-598. Available from: http://content.wkhealth.com/linkback/openurl?sid=WKPTLP:landingpage&an=00054725-200904000-00018 doi: 10.1002/ibd.20794. [Google Scholar]
Sass C, Belin S, Chatain C, Moulin J, Debout M, Duband S. [Social vulnerability is more frequent in victims of interpersonal violence: value of the EPICES score].. Presse Med 2009;38(6):881-892. Available from: https://www.nlm.nih.gov/medlineplus/familyissues.html PubMed PMID: 19185448. doi: 10.1016/j.lpm.2008.10.016. [Google Scholar]
Ribeiro ERO, Guimarães AMDN, Bettiol H, Lima DDF, Almeida MLD, de Souza L, et al. Risk factors for inadequate prenatal care use in the metropolitan area of Aracaju, Northeast Brazil. BMC Pregnancy Childbirth 2009;9(1):31. Available from: http://bmcpregnancychildbirth.biomedcentral.com/articles/10.1186/1471-2393-9-31 PubMed PMID: 19622174. doi: 10.1186/1471-2393-9-31. [Google Scholar]
Labbe E, Moulin JJ, Gueguen R. Un indicateur de mesure de la précarité et de la "santé sociale": le score EPICES. L'expérience des Centres d'examens de santé de l'assurance maladie.. La Revue de l'Ires 2007;53(1):3. Available from: http://www.cairn.info/revue-de-l-ires-2007-1-page-3.htm doi: 10.3917/rdli.053.0003. [Google Scholar]
Bihan H, Laurent S, Sass C, Nguyen G, Huot C, Moulin JJ, et al. Association among individual deprivation, glycemic control, and diabetes complications: the EPICES score.. Diabetes Care 2005;28(11):2680-2685. Available from: http://www.diseaseinfosearch.org/result/2236 PubMed PMID: 16249539. doi: 10.2337/diacare.28.11.2680. [Google Scholar]
Inserm . Epidémiologie. Principes et méthodes quantitatives. . [Google Scholar]
Huynh M, Parker JD, Harper S, Pamuk E, Schoendorf KC. Contextual effect of income inequality on birth outcomes. Int J Epidemiol 2005 Apr;34(4):888-895. Available from: http://ije.oxfordjournals.org/cgi/pmidlookup?view=long&pmid=15860635 PubMed PMID: 15860635. doi: 10.1093/ije/dyi092. [Google Scholar]
Reime B, Ratner PA, Tomaselli-Reime SN, Kelly A, Schuecking BA, Wenzlaff P. The role of mediating factors in the association between social deprivation and low birth weight in Germany. Soc Sci Med 2006;62(7):1731-1744. Available from: http://www.scholaruniverse.com/ncbi-linkout?id=16236414 PubMed PMID: 16236414. doi: 10.1016/j.socscimed.2005.08.017. [Google Scholar]
Thompson JMD, Irgens LM, Rasmussen S, Daltveit AK. Secular trends in socio-economic status and the implications for preterm birth. Paediatr Perinat Epidemiol 2006;20(3):182-187. Available from: http://www.scholaruniverse.com/ncbi-linkout?id=16629692 PubMed PMID: 16629692. doi: 10.1111/j.1365-3016.2006.00711.x. [Google Scholar]
Gray R, Bonellie SR, Chalmers J, Greer I, Jarvis S, Williams C. Social inequalities in preterm birth in Scotland 1980-2003: findings from an area-based measure of deprivation. BJOG 2008;115(1):82-90. Available from: http://dx.doi.org/10.1111/j.1471-0528.2007.01582.x PubMed PMID: 18053104. doi: 10.1111/j.1471-0528.2007.01582.x. [Google Scholar]
Smith LK, Draper ES, Manktelow BN, Field DJ. Deprivation and infection among spontaneous very preterm births.. Obstet Gynecol 2007;110(2 Pt 1):325-329. Available from: http://www.scholaruniverse.com/ncbi-linkout?id=17666607 PubMed PMID: 17666607. doi: 10.1097/01.AOG.0000270158.57566.2f. [Google Scholar]
Janevic T, Stein CR, Savitz DA, Kaufman JS, Mason SM, Herring AH. Neighborhood deprivation and adverse birth outcomes among diverse ethnic groups.. Ann Epidemiol 2010;20(6):445-451. Available from: http://europepmc.org/abstract/MED/20470971 PubMed PMID: 20470971. doi: 10.1016/j.annepidem.2010.02.010. [Google Scholar]
Raatikainen K, Heiskanen N, Heinonen S. Under-attending free antenatal care is associated with adverse pregnancy outcomes. BMC Public Health 2007;7(1):268. Available from: http://bmcpublichealth.biomedcentral.com/articles/10.1186/1471-2458-7-268 PubMed PMID: 17900359. doi: 10.1186/1471-2458-7-268. [Google Scholar]
Convers M. Use of the EPICES score to detect precariousness and optimise the care of pregnancy. La Revue Sage-Femme 2010;9(1):3-9. Available from: http://linkinghub.elsevier.com/retrieve/pii/S163740880900217X doi: 10.1016/j.sagf.2009.12.003. [Google Scholar]
Maître C. Sport and pregnancy: a necessary prescription. Science & Sports 2013;28(2):103-108. Available from: http://linkinghub.elsevier.com/retrieve/pii/S0765159713000257 doi: 10.1016/j.scispo.2013.01.006. [Google Scholar]
Domenjoz I, Kayser B, Boulvain M. Effect of physical activity during pregnancy on mode of delivery.. Am J Obstet Gynecol 2014;211(4):401-401. Available from: http://www.diseaseinfosearch.org/result/5922 PubMed PMID: 24631706. doi: 10.1016/j.ajog.2014.03.030. [Google Scholar]