To examine the perinatal outcomes of women who experience social disadvantage using
population-based perinatal data collected between 1999 and 2016.
Population-based, retrospective cohort study.
Population or Sample
A total of 1,188,872 singleton births were included.
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).
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
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.