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Perinatal outcomes of socially disadvantaged women in Victoria, Australia: A population-based retrospective cohort study of 1,188,872 singleton births 1999-2016

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      Objective

      To examine the perinatal outcomes of women who experience social disadvantage using population-based perinatal data collected between 1999 and 2016.

      Design

      Population-based, retrospective cohort study.

      Setting

      Victoria, Australia.

      Population or Sample

      A total of 1,188,872 singleton births were included.

      Methods

      Cohort study using routinely collected perinatal data. Multiple logistic regression was performed to determine associations between social disadvantage and adverse maternal and neonatal outcomes with confidence limits set at 99%. Time trend analysis for perinatal outcomes was performed in relation to area level disadvantage measures.

      Main outcome measures

      Incidence of maternal admission to Intensive Care Unit (ICU), postpartum haemorrhage (PPH) and caesarean section, perinatal mortality, preterm birth, low birthweight (LBW), and admission to special care nursery/neonatal intensive care unit (SCN/NICU).

      Results

      Social disadvantage was associated with higher odds of adverse perinatal outcomes. Disadvantaged women were more likely to be admitted to ICU, have a PPH or experience perinatal mortality (stillbirth or neonatal death) and their neonates more likely to be admitted to SCN/NICU, be born preterm and be LBW. A persistent social gradient existed across time for the most disadvantaged women for all outcomes except caesarean section.

      Conclusions

      Social disadvantage has a marked negative impact on perinatal outcomes. This aligns with national and international evidence regarding the impact of disadvantage. Strategies that improve access to, and reduce fragmentation in, maternity care in addition to initiatives that address the social determinants of health may contribute to improving perinatal outcomes for socially disadvantaged women.
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