Pregnancy outcome,infant mortality and mother's education in Piedmont from 1980 to 1995

The paper describes 1980-1995 trends in social differences in reproductive outcomes and infant mortality in Piedmont, Italy. By means of a logistic model, risk differences by mothers'educational level were calculated for low birthweight, stillbirth, neonatal, postneonatal and infant mortality in four time periods (1980-83, 1984-87, 1988-91, 1992-95). Odds ratios of low birthweight for children born to mothers in the lowest educational class compared to the highest are slightly increasing (from 1.43 to 1.57), while those between highest and intermediate educational groups are small and steady. After adjustment for selected confounding variables, for which data were available, these differences are confirmed. Differences in risk for neonatal mortality between highest and intermediate educational groups have strongly reduced from the beginning of the Nineties, while they have increased between highest and lowest classes. Adjusting for birthweight, differences disappear. Postneonatal mortality is strongly related to low educational level and differences are widening: OR for lowest educational level has increased from 1.96 to 2.60. Even within a fairly good health system, social differences are present. Hospital assistance has always been equitable to all new-borns; social differences generate in the environment where pregnant women and infants live. Due to the high attributable risk on infant mortality, reduction in social differences in low birthweight should be considered a priority in public health policy in Piedmont.