Neighbourhood Income and Risk of Having an Infant With Concomitant Preterm Birth and Severe Small for Gestational Age Birth Weight |
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| Affiliation: | 1. Dalla Lana School of Public Health, University of Toronto, Toronto, ON;2. Centre for Urban Health Solutions, The Keenan Research Centre in the Li Ka Shing Knowledge Institute, St. Michael''s Hospital, Toronto, ON;3. Research and Analysis, ICES, Toronto, ON;4. Faculty of Medicine and Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON;5. Women''s College Research Institute, Women''s College Hospital, Toronto, ON;6. Department of Psychiatry, University of Toronto, Toronto, ON.;7. Gillings School of Global Public Health, University of North Carolina-Chapel Hill, Chapel Hill, NC;8. Department of Medicine, St. Michael''s Hospital, Toronto, ON;9. Department of Obstetrics and Gynaecology, St. Michael''s Hospital, Toronto, ON;1. Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynaecology, Schulich School of Medicine and Dentistry, Western University, London, ON;2. Division of Interventional Radiology, Department of Medical Imaging, Schulich School of Medicine and Dentistry, Western University, London, ON;3. Division of Urogynaecology, Department of Obstetrics and Gynaecology, Schulich School of Medicine and Dentistry, Western University, London, ON;1. Rédacteur en chef, JOGC;2. Rédactrice adjointe, JOGC;1. Editor-in-chief, JOGC;2. Managing editor, JOGC |
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| Abstract: | ObjectiveSocioeconomic position gradients have been individually demonstrated for preterm birth (PTB) at <37 weeks gestation and severe small for gestational age birth weight at <5th percentile (SGA). It is not known how neighbourhood income is related to the combination of PTB and severe SGA, a state reflective of greater placental dysfunction and higher risk of neonatal morbidity and mortality than PTB or severe SGA alone.MethodsThis population-based study comprised all 1 367 656 singleton live births in Ontario from 2002 to 2011. Multinomial logistic regression was used to estimate the odds of PTB with severe SGA, PTB without severe SGA, and severe SGA without PTB, compared with neither PTB nor severe SGA, in relation to neighbourhood income quintile (Q). The highest income quintile, Q5, served as the exposure referent. Adjusted odds ratios (aORs) were adjusted for maternal age at delivery, parity, marital status, and world region of birth (Canadian Task Force Classification II-2).ResultsRelative to women residing in Q5 (2.3 per 1000), the rate of PTB with severe SGA was highest among those in Q1 (3.6 per 1000), with an aOR of 1.34 (95% confidence interval [CI] 1.20–1.50). The corresponding aORs were 1.23 (95% CI 1.09–1.37) for Q2, 1.14 (95% CI 1.02–1.28) for Q3, and 1.06 (95% CI 0.95–1.20) for Q4. Less pronounced aORs were seen for each individual outcome of PTB and severe SGA.ConclusionWomen residing in the lowest-income areas are at highest risk of having a fetus born too small and too soon. Future research should focus on identifying those women most predisposed to combined PTB and severe SGA. |
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