Data were available on 7,359 women belonging to 71 area-postcodes. Of these women 37,8% was resident within a deprived neighbourhood (n = 23 area-postcodes) and 62,2% outside of a deprived neighbourhood (n = 48 area-postcodes). Considerable differences in pregnancy outcomes were apparent across deprived and non-deprived neighbourhoods (Table ). Overall perinatal mortality encompassing intrauterine and neonatal death was 0.7% (55/7,359). Women residing within a deprived neighbourhood had almost a twofold increase in risk for perinatal death as compared to women residing outside of a deprived neighbourhood (RR 1.8, 95% CI [1.08; 3.11]). This difference was mainly explained by the substantially higher number of intrauterine fetal deaths in deprived neighbourhood pregnancies (20/2,779 versus 17/4,580). Nearly all other adverse pregnancy including IUGR, pre-eclampsia, low birth weight, prematurity, and Apgar <7, showed higher prevalences in pregnancies from deprived neighbourhoods. In contrast, the risks for hospital delivery, elective caesarean section, and instrumental vaginal were similar.
Percentages and relative risks of pregnancy outcomes according to neighbourhood classification
Maternal characteristics and risk factors are presented in Table . Forty percent of the study population was of non-Western descent (n = 2,903). The majority of these women resided within a deprived neighbourhood (1,660/2,779). We observed large differences in the prevalence of sociodemographic, lifestyle, obstetrical, and health-related determinants between women living within and outside of a deprived neighbourhood. Deprived neighbourhood’ women were younger, had lower measures of socioeconomic status, and suffered more often from obesity, psychopathology, and STDs (all P < 0.05). We also observed higher percentages of unplanned pregnancies among these women as well as higher percentages of adverse lifestyle factors including smoking or no folic acid use.
Prenatal maternal characteristics according to neighbourhood classification
Logistic regression (with ‘Adverse Outcome’ as outcome) consistently showed strong effects for the risk factors non-Western and Afro-African ethnicity, low income, BMI < 20, smoking, nulliparity, complications in previous pregnancy, and two interaction-terms (low age × single; and Afro-African ethnicity × single; Table ). We observed minor differences across the five datasets as well as in the forward/backward approaches (“Appendix 2
”). In none of these analyses, living within a deprived neighbourhood emerged as significant independent risk factor. Additional prediction of ‘living within a deprived neighbourhood’ from the same risk set provided the same solution (equal risk factors) as the analysis predicting ‘Adverse Outcome’. Apparently, in the present study the effect of neighbourhood deprivation on perinatal outcome was explained by a differential prevalence of individual risk factors (intermediate factors).
Association between individual risk factors and the occurrence of ‘Adverse Outcome’, results from five imputed datasets and forward and backward regression respectively
In Fig. the summated risk scores for women from a deprived neighbourhood are shown (35.8% high-risk score for women from a deprived neighbourhood versus 15.1% high-risk score for women from a non-deprived neighbourhood). The figure graphically supports the key role of individual risk excess in deprived neighbourhood areas.
Fig. 1 Distribution of individual weighted risk scores for women residing within and outside of a deprived neighbourhood. The graph represents the distribution of individual weighted risk scores between deprived and non-deprived neighbourhoods. Differences in (more ...)
Lastly, Fig. shows that women residing within a deprived neighbourhood have significantly more ‘possibly avoidable’ risk factors as compared to women from of a non-deprived neighbourhood.
Fig. 2 ‘Possibly avoidable’ and ‘possibly non-avoidable’ weighted risk scores according to neighbourhood classification. The graphs represent the distributions of ‘possibly avoidable’ and ‘possibly non-avoidable’ (more ...)