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      Socio-economic disparities in pregnancy outcome: why do the poor fare so poorly?

      1 , , ,
      Paediatric and perinatal epidemiology
      Wiley

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          Abstract

          In this paper, we review the evidence bearing on socio-economic disparities in pregnancy outcome, focusing on aetiological factors mediating the disparities in intrauterine growth restriction (IUGR) and preterm birth. We first summarise what is known about the attributable determinants of IUGR and preterm birth, emphasising their quantitative contributions (aetiological fractions) from a public health perspective. We then review studies relating these determinants to socio-economic status and, combined with the evidence about their aetiological fractions, reach some tentative conclusions about their roles as mediators of the socio-economic disparities. Cigarette smoking during pregnancy appears to be the most important mediating factor for IUGR, with low gestational weight gain and short stature also playing substantial roles. For preterm birth, socio-economic gradients in bacterial vaginosis and cigarette smoking appear to explain some of the socio-economic disparities; psychosocial factors may prove even more important, but their aetiological links with preterm birth require further clarification. Research that identifies and quantifies the causal pathways and mechanisms whereby social disadvantage leads to higher risks of IUGR and preterm birth may eventually help to reduce current disparities and improve pregnancy outcome across the entire socio-economic spectrum.

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          Author and article information

          Journal
          Paediatr Perinat Epidemiol
          Paediatric and perinatal epidemiology
          Wiley
          0269-5022
          0269-5022
          Jul 2000
          : 14
          : 3
          Affiliations
          [1 ] Department of Pediatrics, McGill University, Canada. mkrame@po-box.magill.ca
          Article
          10.1046/j.1365-3016.2000.00266.x
          10949211
          c49857d7-24d6-466f-9910-0180baebd4e0
          History

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