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Dundas R, Boroujerdi M, Browne S, Deidda M, Bradshaw P, Craig P, McIntosh E, Parkes A, Wight D, Wright C, Leyland AH. Evaluation of the Healthy Start voucher scheme on maternal vitamin use and child breastfeeding: a natural experiment using data linkage. PUBLIC HEALTH RESEARCH 2023; 11:1-101. [PMID: 37953640 DOI: 10.3310/rteu2107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2023] Open
Abstract
Background Having a good start in life during pregnancy and infancy has been shown to be important for living both a healthy life and a longer life. Despite the introduction of many policies for the early-years age group, including voucher schemes, with the aim of improving nutrition, there is limited evidence of their impact on health. Objectives To assess the effectiveness of the Healthy Start voucher scheme on infant, child and maternal outcomes, and to capture the lived experiences of the Healthy Start voucher scheme for low-income women. Design This was a natural experiment study using existing data sets, linked to routinely collected health data sets, with a nested qualitative study of low-income women and an assessment of the health economics. Setting Representative sample of Scottish children and UK children. Participants Growing Up in Scotland cohort 2 (n = 2240), respondents to the 2015 Infant Feeding Study (n = 8067) and a sample of 40 participants in the qualitative study. Interventions The Health Start voucher, a means-tested scheme that provides vouchers worth £3.10 per week to spend on liquid milk, formula milk, fruit and vegetables. Main outcome measures Infant and child outcomes - breastfeeding initiation and duration; maternal outcomes - vitamin use pre and during pregnancy. Results The exposed group were women receiving the Healthy Start voucher (R), with two control groups: eligible and not claiming the Healthy Start voucher (E) and nearly eligible. There was no difference in vitamin use during pregnancy for either comparison (receiving the Healthy Start voucher, 82%; eligible and not claiming the Healthy Start voucher, 86%; p = 0.10 vs. receiving the Healthy Start voucher, 87%; nearly eligible, 88%; p = 0.43) in the Growing Up in Scotland cohort. Proportions were similar for the Infant Feeding Study cohort (receiving the Healthy Start voucher, 89%; eligible and not claiming the Healthy Start voucher, 86%; p = 0.01 vs. receiving the Healthy Start voucher, 89%; nearly eligible, 87%; p = 0.01); although results were statistically significantly different, these were small effect sizes. There was no difference for either comparison in breastfeeding initiation or breastfeeding duration in months in Growing Up in Scotland, but there was a negative effect of the Healthy Start voucher in the Infant Feeding Survey. This contrast between data sets indicates that results are inconclusive for breastfeeding. The qualitative study found that despite the low monetary value the women valued the Healthy Start voucher scheme. However, the broader lives of low-income women are crucial to understand the constraints to offer a healthy diet. Limitations Owing to the policy being in place, it was difficult to identify appropriate control groups using existing data sources, especially in the Infant Feeding Study. Conclusions As the Healthy Start voucher scheme attempts to influence health behaviour, this evaluation can inform other policies aiming to change behaviour and use voucher incentives. The null effect of Healthy Start vouchers on the primary outcomes may be due to the value of the vouchers being insufficient to change the broader lives of low-income women to offer a healthy diet. Future work The methods developed to undertake an economic evaluation alongside a natural experiment using existing data can be used to explore the cost-effectiveness of the Healthy Start voucher scheme. Funding This project was funded by the National Institute for Health and Care Research (NIHR) Public Health Research programme and will be published in full in Public Health Research; Vol. 11, No. 11. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Ruth Dundas
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow, UK
| | - Massoud Boroujerdi
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow, UK
| | - Susan Browne
- General Practice and Primary Care, University of Glasgow, Glasgow, UK
| | - Manuela Deidda
- Health Economics and Health Technology Assessment, University of Glasgow, Glasgow, UK
| | | | - Peter Craig
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow, UK
| | - Emma McIntosh
- Health Economics and Health Technology Assessment, University of Glasgow, Glasgow, UK
| | - Alison Parkes
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow, UK
| | - Daniel Wight
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow, UK
| | - Charlotte Wright
- School of Medicine, Dentistry & Nursing, University of Glasgow, Glasgow, UK
| | - Alastair H Leyland
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow, UK
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Behlim T, Basso O, Bushnik T, Kramer MS, Kaufman JS, Yang S. Differences in birthweight by maternal and paternal nativity status in Canada. Paediatr Perinat Epidemiol 2022; 36:113-122. [PMID: 34811763 DOI: 10.1111/ppe.12817] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Revised: 08/25/2021] [Accepted: 08/27/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND Parental nativity, as well as duration of residence of foreign-born parents in the host country, has been shown to be associated with size at birth. However, most studies have focused on maternal nativity status only and have not accounted for important characteristics of both parents. OBJECTIVE To explore whether maternal and paternal nativity and length of residence (LOR) are independently associated with birthweight for gestational age in a representative sample of infants in Canada. METHODS We compared mean differences in sex- and gestational age-standardised birthweight z-score by nativity status of both parents in a nationally representative sample of 130,532 singleton infants born between May 2004 and May 2006 to mothers residing in Canada. We categorised parental nativity status into four groups (both parents Canada-born, mother only foreign-born, father only foreign-born and both parents foreign-born) and parents' LOR into three (both ≤10 years, only one parent ≤10 years and both >10 years). We estimated mean differences in birthweight z-score and their 95% confidence intervals in linear regression models adjusted for parity, parents' ages, education, ethnicity and marital status of the mother. RESULTS Compared with babies of Canada-born couples, those of two foreign-born parents had on average smaller birthweight z-score, -0.23 (95% CI -0.28, -0.25). However, after adjustment, the mean difference in z-score was -0.02 (95% CI -0.05, 0.00). Infants born to parents who had both resided in Canada for ≤10 years had a unadjusted mean difference in z-score of -0.27 (95% CI -0.29, -0.26), compared infants whose parents were both Canada-born, but the difference became negligible (-0.02, 95% CI -0.04, 0.01) after adjustment. CONCLUSION The birthweight differences by parental nativity or length of residence observed in our study population could be attributed to differences in the distribution of other parental characteristics that affect birthweight.
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Affiliation(s)
- Tarannum Behlim
- Department of Epidemiology, Biostatistics and Occupational Health, Faculty of Medicine, McGill University, Montreal, QC, Canada
| | - Olga Basso
- Department of Epidemiology, Biostatistics and Occupational Health, Faculty of Medicine, McGill University, Montreal, QC, Canada.,Department of Obstetrics and Gynecology, Faculty of Medicine, Montreal, QC, Canada
| | | | - Michael S Kramer
- Department of Epidemiology, Biostatistics and Occupational Health, Faculty of Medicine, McGill University, Montreal, QC, Canada.,Department of Paediatrics, Faculty of Medicine, McGill University, Montreal, QC, Canada
| | - Jay S Kaufman
- Department of Epidemiology, Biostatistics and Occupational Health, Faculty of Medicine, McGill University, Montreal, QC, Canada
| | - Seungmi Yang
- Department of Epidemiology, Biostatistics and Occupational Health, Faculty of Medicine, McGill University, Montreal, QC, Canada
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Baldwin H, Biehal N, Allgar V, Cusworth L, Pickett K. Antenatal risk factors for child maltreatment: Linkage of data from a birth cohort study to child welfare records. CHILD ABUSE & NEGLECT 2020; 107:104605. [PMID: 32590228 DOI: 10.1016/j.chiabu.2020.104605] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/12/2020] [Revised: 06/05/2020] [Accepted: 06/08/2020] [Indexed: 05/12/2023]
Abstract
BACKGROUND Understanding the risk factors for child maltreatment is critical to efforts to reduce its prevalence. OBJECTIVE This study investigated the association between characteristics and circumstances of mothers during pregnancy and the subsequent identification of concerns about child maltreatment. PARTICIPANTS AND SETTING The study drew on two data sets: (i) data from questionnaires administered to the expectant mothers of 11,332 children born in a deprived multi-ethnic local authority in England between 2007 and 2011, for a birth cohort study, and (ii) administrative data on children referred to child welfare services. METHODS The linkage of these two pre-existing data sets enabled the prospective study of risk factors for child maltreatment. RESULTS A range of factors captured during the antenatal period were associated with an increased likelihood of subsequent recorded child maltreatment concerns, including: younger maternal age (HR=0.96; p < .001), lower maternal education level (HR=1.36; p < .001), maternal mental illness (HR=1.17; p = .001), maternal smoking in pregnancy (HR=1.69; p < .001), single motherhood (HR=1.41; p = .022), larger family size (HR=1.13; p < .001), multiple deprivation (HR=1.01; p = .011), social housing (HR=1.72; p < .001), paternal unemployment (HR=1.79; p < .001), and the receipt of means-tested welfare benefits (HR=1.43; p < .001). A greater total number of risk factors during pregnancy also increased the risk of subsequent maltreatment concerns (HR=1.45; p < .001). CONCLUSIONS The identification of multiple risk factors in this study supports claims that single targeted interventions are unlikely to be successful in preventing or reducing child maltreatment due to its multifactorial nature, and that multidimensional interventions are required.
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Affiliation(s)
- Helen Baldwin
- Department of Social Policy and Social Work, University of York, York, YO10 5DD, England, United Kingdom.
| | - Nina Biehal
- Department of Social Policy and Social Work, University of York, York, YO10 5DD, England, United Kingdom.
| | - Victoria Allgar
- Department of Health Sciences, University of York, YO10 5DD, York, England, United Kingdom.
| | - Linda Cusworth
- Department of Social Policy and Social Work, University of York, York, YO10 5DD, England, United Kingdom.
| | - Kate Pickett
- Department of Health Sciences, University of York, YO10 5DD, York, England, United Kingdom.
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Li Y, Quigley MA, Macfarlane A, Jayaweera H, Kurinczuk JJ, Hollowell J. Ethnic differences in singleton preterm birth in England and Wales, 2006-12: Analysis of national routinely collected data. Paediatr Perinat Epidemiol 2019; 33:449-458. [PMID: 31642102 PMCID: PMC6900067 DOI: 10.1111/ppe.12585] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2019] [Revised: 05/08/2019] [Accepted: 07/01/2019] [Indexed: 11/30/2022]
Abstract
BACKGROUND Data recorded at birth and death registration in England and Wales have been routinely linked with data recorded at birth notification since 2006. These provide scope for detailed analyses on ethnic differences in preterm birth (PTB). OBJECTIVES We aimed to investigate ethnic differences in PTB and degree of prematurity in England and Wales, taking into account maternal sociodemographic characteristics and to further explore the contribution of mother's country of birth to these ethnic differences in PTB. METHODS We analysed PTB and degree of prematurity by ethnic group, using routinely collected and linked data for all singleton live births in England and Wales, 2006-2012. Logistic regression was used to adjust for mother's age, marital status/registration type, area deprivation and mother's country of birth. RESULTS In the 4 634 932 births analysed, all minority ethnic groups except 'Other White' had significantly higher odds of PTB compared with White British babies (ORs between 1.04-1.25); highest odds were in Black Caribbean, Indian, Bangladeshi and Pakistani groups. Ethnic differences in PTB tended to be greater at earlier gestational ages. In all ethnic groups, odds of PTB were lower for babies whose mothers were born outside the UK. CONCLUSIONS In England and Wales, Black Caribbean, Indian, Bangladeshi, Pakistani and Black African babies all have significantly increased odds of being born preterm compared with White British babies. Bangladeshis apart, these groups are particularly at risk of extremely PTB. In all ethnic groups, the odds of PTB are lower for babies whose mothers were born outside the UK. These ethnic differences do not appear to be wholly explained by area deprivation or other sociodemographic characteristics.
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Affiliation(s)
- Yangmei Li
- Policy Research Unit in Maternal Health and CareNational Perinatal Epidemiology UnitNuffield Department of Population HealthUniversity of OxfordOxfordUK
| | - Maria A. Quigley
- Policy Research Unit in Maternal Health and CareNational Perinatal Epidemiology UnitNuffield Department of Population HealthUniversity of OxfordOxfordUK
| | - Alison Macfarlane
- Centre for Maternal and Child Health ResearchSchool of Health Sciences, CityUniversity of LondonLondonUK
| | | | - Jennifer J. Kurinczuk
- Policy Research Unit in Maternal Health and CareNational Perinatal Epidemiology UnitNuffield Department of Population HealthUniversity of OxfordOxfordUK
| | - Jennifer Hollowell
- Policy Research Unit in Maternal Health and CareNational Perinatal Epidemiology UnitNuffield Department of Population HealthUniversity of OxfordOxfordUK
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Garcia R, Ali N, Guppy A, Griffiths M, Randhawa G. Ethnic differences in risk factors for adverse birth outcomes between Pakistani, Bangladeshi, and White British mothers. J Adv Nurs 2019; 76:174-182. [PMID: 31566783 DOI: 10.1111/jan.14209] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2019] [Revised: 07/31/2019] [Accepted: 08/28/2019] [Indexed: 11/29/2022]
Abstract
AIM Reducing poor maternal and infant outcomes in pregnancy is the aim of maternity care. Adverse health behaviours lead to increased risk and can adversely mediate birth outcomes. This study examines whether risk factors are similar, different, or clustered according to maternal ethnicity. DESIGN Retrospective analysis of routinely collected data (2008-2013). METHODS We analysed data routinely collected data from a local University Hospital Ciconia Maternity information System (CMiS), for White British, Pakistani, and Bangladeshi women (N = 15,211) using cross-tabulations, ANCOVA, adjusted standardized residuals (ASR), and Pearson's chi-squared statistics. RESULTS The results demonstrate distinct clusters of risk factors between White British, Pakistani, and Bangladeshi mothers. Additionally, Pakistani mothers had the highest number of statistically significant risk factors, according to maternal ethnicity, showing that 49% of women in this cohort that were diagnosed with diabetes were Pakistani, 21.5% of White British women smoked and results showed that Bangladeshi mothers delivered the lightest weight infants (adjusted mean: 3,055.4 g). CONCLUSIONS This study showed differences in the risk factors between White British, Pakistani, and Bangladeshi mothers. The identified risk factors were clustered by maternal ethnicity. IMPACT Identification of these risk factor clusters can help policymakers and clinicians direct resources and may help reduce ethnic variation found in these populations that might be attributed to adverse health behaviours and increased risk factors.
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Affiliation(s)
- Rebecca Garcia
- Faculty of Wellbeing, Education and Language Studies, Open University, Milton Keynes, UK
| | - Nasreen Ali
- The Institute for Health Research, University of Bedfordshire, Luton, UK
| | - Andrew Guppy
- The Institute for Applied Social Sciences, University of Bedfordshire, Luton, UK
| | - Malcolm Griffiths
- Luton &Dunstable University Hospital NHS Foundation Trust, Luton, UK
| | - Gurch Randhawa
- The Institute for Health Research, University of Bedfordshire, Luton, UK
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Bielemeyer M, Rothschild MA, Schmolling JC, Eifinger F, Banaschak S. Length, weight and head circumference as reliable signs of maturity in a modern German birth collective. Forensic Sci Int 2018; 293:17-23. [DOI: 10.1016/j.forsciint.2018.10.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2018] [Accepted: 10/17/2018] [Indexed: 11/25/2022]
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Leyland AH, Ouédraogo S, Nam J, Bond L, Briggs AH, Gray R, Wood R, Dundas R. Evaluation of Health in Pregnancy grants in Scotland: a natural experiment using routine data. PUBLIC HEALTH RESEARCH 2017. [DOI: 10.3310/phr05060] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
Background
Pregnancy and the period around birth are critical for the development and improvement of population health as well as the health of mothers and babies, with outcomes such as birthweight influencing adult health.
Objectives
We evaluated the clinical effectiveness and cost-effectiveness of the Health in Pregnancy (HiP) grants in Scotland, looking for differential outcomes when the scheme was in place, as well as before its implementation and after its withdrawal.
Design
The HiP grants were evaluated as a natural experiment using interrupted time series analysis. We had comparison groups of women who delivered before the grants were introduced and after the grants were withdrawn.
Setting
Scotland, UK.
Participants
A total of 525,400 singleton births delivered between 24 and 44 weeks in hospitals across Scotland between 1 January 2004 and 31 December 2014.
Intervention
The HiP grant was a universal, unconditional cash transfer of £190 for women in Great Britain and Northern Ireland reaching 25 weeks of pregnancy if they had sought health advice from a doctor or midwife. The grant was introduced for women with a due date on or after 6 April 2009 and subsequently withdrawn for women reaching the 25th week of pregnancy on or after 1 January 2011. The programme was paid for by Her Majesty’s Treasury.
Main outcome measures
Our primary outcome measure was birthweight. Secondary outcome measures included maternal behaviour, measures of size, measures of stage and birth outcomes.
Data sources
The data came from the Scottish maternity and neonatal database held by the Information and Services Division at the NHS National Services Scotland.
Results
There was no statistically significant effect on birthweight, with births during the intervention period being, on average, 2.3 g [95% confidence interval (CI) –1.9 to 6.6 g] lighter than would have been expected had the pre-intervention trend continued. Mean gestational age at booking (i.e. the first antenatal appointment with a health-care professional) decreased by 0.35 weeks (95% CI 0.29 to 0.41 weeks) and the odds of booking before 25 weeks increased by 10% [odds ratio (OR) 1.10, 95% CI 1.02 to 1.18] during the intervention but decreased again post intervention (OR 0.91, 95% CI 0.83 to 1.00). The odds of neonatal death increased by 84% (OR 1.84, 95% CI 1.22 to 2.78) and the odds of having an emergency caesarean section increased by 7% (OR 1.07, 95% CI 1.03 to 1.10) during the intervention period.
Conclusions
The decrease in the odds of booking before 25 weeks following withdrawal of the intervention makes it likely that the HiP grants influenced maternal health-care-seeking behaviour. It is unclear why neonatal mortality and emergency caesarean section rates increased, but plausible explanations include the effects of the swine flu outbreak in 2009 and the global financial crisis. The study is limited by its non-randomised design. Future research could assess an eligibility threshold for payment earlier than the 25th week of pregnancy.
Funding
The National Institute for Health Research Public Health Research programme. The Social and Public Health Sciences Unit is core funded by the Medical Research Council (MC_UU_12017/13) and the Scottish Government Chief Scientist Office (SPHSU13).
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Affiliation(s)
- Alastair H Leyland
- Social and Public Health Sciences Unit, University of Glasgow, Glasgow, UK
| | - Samiratou Ouédraogo
- University of Montréal Hospital Research Centre, University of Montréal, Montréal, QC, Canada
| | | | - Lyndal Bond
- College of Health and Biomedicine, Victoria Hospital, Melbourne, VIC, Australia
| | | | - Ron Gray
- National Perinatal Epidemiology Unit, University of Oxford, Oxford, UK
| | - Rachael Wood
- Information Service Division, NHS National Services Scotland, Edinburgh, UK
| | - Ruth Dundas
- Social and Public Health Sciences Unit, University of Glasgow, Glasgow, UK
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Petherick ES, Fairley L, Parslow RC, McEachan R, Tuffnell D, Pickett KE, Leon D, Lawlor DA, Wright J. Ethnic differences in the clustering and outcomes of health behaviours during pregnancy: results from the Born in Bradford cohort. J Public Health (Oxf) 2017; 39:514-522. [PMID: 27614098 DOI: 10.1093/pubmed/fdw098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2016] [Accepted: 08/16/2016] [Indexed: 11/13/2022] Open
Abstract
Background Pregnancy is a time of optimal motivation for many women to make positive behavioural changes. We aim to describe pregnant women with similar patterns of self-reported health behaviours and examine associations with birth outcomes. Methods We examined the clustering of multiple health behaviours during pregnancy in the Born in Bradford cohort, including smoking physical inactivity, vitamin d supplementation and exposure to second-hand smoke. Latent class analysis was used to identify groups of individuals with similar patterns of health behaviours separately for White British (WB) and Pakistani mothers. Multinomial regression was then used to examine the association between group membership and birth outcomes, which included preterm birth and mean birthweight. Results For WB mothers, offspring of those in the 'Unhealthiest' group had lower mean birthweight than those in the 'Mostly healthy but inactive' class, although no association was observed for preterm birth. For Pakistani mothers, group membership was not associated with birthweight differences, although the odds of preterm birth was higher in 'Inactive smokers' compared to the 'Mostly healthy but inactive' group. Conclusions The use of latent class methods provides important information about the clustering of health behaviours which can be used to target population segments requiring behaviour change interventions considering multiple risk factors. Given the dominant negative association of smoking with the birth outcomes investigated, latent class groupings of other health behaviours may not confer additional risk information for these outcomes.
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Affiliation(s)
- E S Petherick
- School of Sport, Exercise & Health Sciences, University of Loughborough, Loughborough, UK
| | - L Fairley
- Division of Epidemiology, University of Leeds, Leeds, UK
| | - R C Parslow
- Division of Epidemiology, University of Leeds, Leeds, UK
| | - R McEachan
- Born in Bradford, Bradford Institute for Health Research, Bradford Royal Infirmary, Bradford, UK
| | - D Tuffnell
- Bradford Teaching Hospitals NHS Foundation Trust, Bradford BD9 6RJ, UK
| | - K E Pickett
- Department of Health Sciences, University of York, Heslington, UK.,Hull York Medical School, University of York, Heslington, UK
| | - D Leon
- Department of Non-Communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
| | - D A Lawlor
- MRC Centre for Causal Analyses in Translational Epidemiology, School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - J Wright
- Born in Bradford, Bradford Institute for Health Research, Bradford Royal Infirmary, Bradford, UK
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Garcia R, Ali N, Guppy A, Griffiths M, Randhawa G. Differences in the pregnancy gestation period and mean birth weights in infants born to Indian, Pakistani, Bangladeshi and white British mothers in Luton, UK: a retrospective analysis of routinely collected data. BMJ Open 2017; 7:e017139. [PMID: 28801435 PMCID: PMC5724131 DOI: 10.1136/bmjopen-2017-017139] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
OBJECTIVE To compare mean birth weights and gestational age at delivery of infants born to Indian, Pakistani, Bangladeshi and white British mothers in Luton, UK. DESIGN Retrospective analysis using routinely recorded secondary data in Ciconia Maternity information System, between 2008 and 2013. SETTING Luton, UK. PARTICIPANTS Mothers whose ethnicity was recorded as white British, Bangladeshi, Pakistani or Indian and living in Luton, aged over 16, who had a live singleton birth over 24 weeks of gestation were included in the analysis (n=14 871). OUTCOME MEASURES Primary outcome measures were mean birth weight and gestational age at delivery. RESULTS After controlling for maternal age, smoking, diabetes, gestation age, parity and maternal height and body mass index at booking, a significant difference in infants' mean birth weight was found between white British and Indian, Pakistani and Bangladeshi infants, F(3, 12 287)=300.32, p<0.0001. The partial Eta-squared for maternal ethnicity was η2=0.067. The adjusted mean birth weight for white British infants was found to be 3377.89 g (95% CI 3365.34 to 3390.44); Indian infants, 3033.09 g (95% CI 3038.63 to 3103.55); Pakistani infants, 3129.49 g (95% CI 3114.5 to 3144.48); and Bangladeshi infants, 3064.21 g (95% CI 3041.36 to 3087.06). There was a significant association in preterm delivery found in primipara Indian mothers, compared with Indian mothers (Wald=8.192, df 1, p<0.005). CONCLUSIONS Results show important differences in adjusted mean birth weight between Indian, Pakistani, Bangladeshi and white British women. Moreover, an association was found between primipara Indian mothers and preterm delivery, when compared with Pakistani, Bangladeshi and white British women.
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Affiliation(s)
- Rebecca Garcia
- The Institute For Health Research, University of Bedfordshire, Bedfordshire, UK
| | - Nasreen Ali
- The Institute For Health Research, University of Bedfordshire, Bedfordshire, UK
| | - Andy Guppy
- The Institute for Applied Social Sciences, University of Bedfordshire, Bedfordshire, UK
| | - Malcolm Griffiths
- Luton & Dunstable University Hospital NHS Foundation Trust, Luton, UK
| | - Gurch Randhawa
- The Institute For Health Research, University of Bedfordshire, Bedfordshire, UK
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Jeganathan R, Karalasingam SD, Hussein J, Allotey P, Reidpath DD. Factors associated with recovery from 1 minute Apgar score <4 in live, singleton, term births: an analysis of Malaysian National Obstetrics Registry data 2010-2012. BMC Pregnancy Childbirth 2017; 17:110. [PMID: 28390414 PMCID: PMC5385027 DOI: 10.1186/s12884-017-1293-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2015] [Accepted: 03/23/2017] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND The neonatal Apgar score at 5 min has been found to be a better predictor of outcomes than the Apgar score at 1 min. A baby, however, must pass through the first minute of life to reach the fifth. There has been no research looking at predictors of recovery (Apgar scores ≥7) by 5 min in neonates with 1 min Apgar scores <4. METHODS An analysis of observational data was conducted using live, singleton, term births recorded in the Malaysian National Obstetrics Registry between 2010 and 2012. A total of 272,472 live, singleton, term births without congential anomalies were recorded, of which 1,580 (0.59%) had 1 min Apgar scores <4. Descriptive methods and bi- and multi-variable logistic regression were used to identify risk factors associated with recovery (5 min Apgar score ≥7) from 1 min Apgar scores <4. RESULTS Less than 1% of births have a 1 min Apgar scores <4. Only 29.4% of neonates with 1 min Apgar scores <4 recover to a 5 min Apgar score ≥7. Among uncomplicated vaginal deliveries, after controlling for other factors, deliveries by a doctor of neonates with a 1 min Apgar score <4 had odds of recovery 2.4 times greater than deliveries of neonates with a 1 min Apgar score <4 by a nurse-midwife. Among deliveries of neonates with a 1 min Apgar score <4 by doctors, after controlling for other factors, planned and unplanned CS was associated with better odds of recovery than uncomplicated vaginal deliveries. Recovery was also associated with maternal obesity, and there was some ethnic variation - in the adjusted analysis indigenous (Orang Asal) Malaysians had lower odds of recovery. CONCLUSIONS A 1 min Apgar score <4 is relatively rare, and less than a third recover by five minutes. In those newborns the qualification of the person performing the delivery and the type of delivery are independent predictors of recovery as is maternal BMI and ethnicity. These are associations only, not necessarily causes, and they point to potential areas of research into health systems factors in the labour room, as well as possible biological and cultural factors.
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Affiliation(s)
- Ravichandran Jeganathan
- Department of Obstetrics and Gynaecology, Sultanah Aminah Hospital, Ministry of Health Malaysia, Johor Bahru, Malaysia
| | - Shamala D. Karalasingam
- National Obstetric Registry, Clinical Research Centre, Ministry of Health Malaysia, Kualar Lumpur, Malaysia
| | - Julia Hussein
- Immpact, University of Aberdeen, Aberdeen, Scotland UK
| | - Pascale Allotey
- South East Asia Community Observatory (SEACO), Monash University Malaysia, Bandar Sunway, Malaysia
- Jeffrey Cheah School of Medicine and Health Sciences, Monash University Malaysia, Bandar Sunway, Selangor 46150 Malaysia
| | - Daniel D. Reidpath
- South East Asia Community Observatory (SEACO), Monash University Malaysia, Bandar Sunway, Malaysia
- Jeffrey Cheah School of Medicine and Health Sciences, Monash University Malaysia, Bandar Sunway, Selangor 46150 Malaysia
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11
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Štípková M. Immigrant disadvantage or the healthy immigrant effect? Evidence about low birth weight differences in the Czech Republic. Eur J Public Health 2016; 26:662-6. [PMID: 27118552 DOI: 10.1093/eurpub/ckw029] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Most of the research about immigrants' birth outcomes comes from countries with high numbers of immigrants. This article provides evidence from the Czech Republic, a country with a short immigration history and a small immigrant population. Two hypotheses are tested: the immigrant disadvantage hypothesis and the healthy immigrant hypothesis. METHODS Live singleton births in 2013-14 from the national birth register are analysed. The odds of low birth weight (LBW) among the native population and five immigrant groups are compared using logistic regression. Control variables include maternal age, parity, education and marital status, paternal immigrant status, age and education. RESULTS All immigrant groups, except for Slovaks, showed smaller odds of LBW than native mothers. Adjusted odds ratios for non-Slovak immigrants range between 0.52 and 0.65. Furthermore, maternal immigrant status interacts with education. There is a wide educational gradient in LBW among Czech and Slovak mothers with low education representing a large disadvantage. Such pattern is not present among other ethnic groups. This makes the outcomes of Czech and Slovak mothers less favourable. Native mothers and immigrants with higher level of education show more similar outcomes. Paternal immigrant status does not have a net effect on LBW when maternal ethnicity is taken into account. CONCLUSIONS Results provide evidence for the healthy immigrant effect. The favourable outcomes of non-Slovak immigrants seem to result from a combination of two factors, health selection of immigrants and relatively high prevalence of LBW in the native population caused by adverse outcomes of mothers with low education.
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Affiliation(s)
- Martina Štípková
- Department of Sociology, University of West Bohemia in Pilsen, Czech Republic
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McKinnon B, Yang S, Kramer MS, Bushnik T, Sheppard AJ, Kaufman JS. Comparison of black-white disparities in preterm birth between Canada and the United States. CMAJ 2016; 188:E19-E26. [PMID: 26553860 PMCID: PMC4695373 DOI: 10.1503/cmaj.150464] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/21/2015] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND A higher risk of preterm birth among black women than among white women is well established in the United States. We compared differences in preterm birth between non-Hispanic black and white women in Canada and the US, hypothesizing that disparities would be less extreme in Canada given the different historical experiences of black populations and Canada's universal health care system. METHODS Using data on singleton live births in Canada and the US for 2004-2006, we estimated crude and adjusted risk ratios and risk differences in preterm birth (< 37 wk) and very preterm birth (< 32 wk) among non-Hispanic black versus non-Hispanic white women in each country. Adjusted models for the US were standardized to the covariate distribution of the Canadian cohort. RESULTS In Canada, 8.9% and 5.9% of infants born to black and white mothers, respectively, were preterm; the corresponding figures in the US were 12.7% and 8.0%. Crude risk ratios for preterm birth among black women relative to white women were 1.49 (95% confidence interval [CI] 1.32 to 1.66) in Canada and 1.57 (95% CI 1.56 to 1.58) in the US (p value for heterogeneity [pH] = 0.3). The crude risk differences for preterm birth were 2.94 (95% CI 1.91 to 3.96) in Canada and 4.63 (95% CI 4.56 to 4.70) in the US (pH = 0.003). Adjusted risk ratios for preterm birth (pH = 0.1) were slightly higher in Canada than in the US, whereas adjusted risk differences were similar in both countries. Similar patterns were observed for racial disparities in very preterm birth. INTERPRETATION Relative disparities in preterm birth and very preterm birth between non-Hispanic black and white women were similar in magnitude in Canada and the US. Absolute disparities were smaller in Canada, which reflects a lower overall risk of preterm birth in Canada than in the US in both black and white populations.
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Affiliation(s)
- Britt McKinnon
- Department of Epidemiology, Biostatistics and Occupational Health (McKinnon, Yang, Kramer, Kaufman), McGill University Faculty of Medicine, Montréal, Que.; Institute for Health and Social Policy (McKinnon, Kaufman), McGill University, Montréal, Que.; Department of Pediatrics (Kramer), McGill University Faculty of Medicine, Montréal, Que.; Health Analysis Division (Bushnik), Statistics Canada, Ottawa, Ont.; AboutKidsHealth (Sheppard), The Hospital for Sick Children, Toronto, Ont.; Dalla Lana School of Public Health (Sheppard), University of Toronto, Toronto, Ont.
| | - Seungmi Yang
- Department of Epidemiology, Biostatistics and Occupational Health (McKinnon, Yang, Kramer, Kaufman), McGill University Faculty of Medicine, Montréal, Que.; Institute for Health and Social Policy (McKinnon, Kaufman), McGill University, Montréal, Que.; Department of Pediatrics (Kramer), McGill University Faculty of Medicine, Montréal, Que.; Health Analysis Division (Bushnik), Statistics Canada, Ottawa, Ont.; AboutKidsHealth (Sheppard), The Hospital for Sick Children, Toronto, Ont.; Dalla Lana School of Public Health (Sheppard), University of Toronto, Toronto, Ont
| | - Michael S Kramer
- Department of Epidemiology, Biostatistics and Occupational Health (McKinnon, Yang, Kramer, Kaufman), McGill University Faculty of Medicine, Montréal, Que.; Institute for Health and Social Policy (McKinnon, Kaufman), McGill University, Montréal, Que.; Department of Pediatrics (Kramer), McGill University Faculty of Medicine, Montréal, Que.; Health Analysis Division (Bushnik), Statistics Canada, Ottawa, Ont.; AboutKidsHealth (Sheppard), The Hospital for Sick Children, Toronto, Ont.; Dalla Lana School of Public Health (Sheppard), University of Toronto, Toronto, Ont
| | - Tracey Bushnik
- Department of Epidemiology, Biostatistics and Occupational Health (McKinnon, Yang, Kramer, Kaufman), McGill University Faculty of Medicine, Montréal, Que.; Institute for Health and Social Policy (McKinnon, Kaufman), McGill University, Montréal, Que.; Department of Pediatrics (Kramer), McGill University Faculty of Medicine, Montréal, Que.; Health Analysis Division (Bushnik), Statistics Canada, Ottawa, Ont.; AboutKidsHealth (Sheppard), The Hospital for Sick Children, Toronto, Ont.; Dalla Lana School of Public Health (Sheppard), University of Toronto, Toronto, Ont
| | - Amanda J Sheppard
- Department of Epidemiology, Biostatistics and Occupational Health (McKinnon, Yang, Kramer, Kaufman), McGill University Faculty of Medicine, Montréal, Que.; Institute for Health and Social Policy (McKinnon, Kaufman), McGill University, Montréal, Que.; Department of Pediatrics (Kramer), McGill University Faculty of Medicine, Montréal, Que.; Health Analysis Division (Bushnik), Statistics Canada, Ottawa, Ont.; AboutKidsHealth (Sheppard), The Hospital for Sick Children, Toronto, Ont.; Dalla Lana School of Public Health (Sheppard), University of Toronto, Toronto, Ont
| | - Jay S Kaufman
- Department of Epidemiology, Biostatistics and Occupational Health (McKinnon, Yang, Kramer, Kaufman), McGill University Faculty of Medicine, Montréal, Que.; Institute for Health and Social Policy (McKinnon, Kaufman), McGill University, Montréal, Que.; Department of Pediatrics (Kramer), McGill University Faculty of Medicine, Montréal, Que.; Health Analysis Division (Bushnik), Statistics Canada, Ottawa, Ont.; AboutKidsHealth (Sheppard), The Hospital for Sick Children, Toronto, Ont.; Dalla Lana School of Public Health (Sheppard), University of Toronto, Toronto, Ont
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Melchior M, Chollet A, Glangeaud-Freudenthal N, Saurel-Cubizolles MJ, Dufourg MN, van der Waerden J, Sutter-Dallay AL. Tobacco and alcohol use in pregnancy in France: the role of migrant status: the nationally representative ELFE study. Addict Behav 2015; 51:65-71. [PMID: 26233939 DOI: 10.1016/j.addbeh.2015.07.015] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2014] [Revised: 07/06/2015] [Accepted: 07/22/2015] [Indexed: 11/25/2022]
Abstract
INTRODUCTION Tobacco and alcohol use in pregnancy are modifiable yet frequent risk factors of poor perinatal outcomes. We examined whether characteristics associated with substance use in pregnancy vary between native and migrant women, who often differ in terms of socio-demographic characteristics. METHODS Data come from a nationally representative sample of children born in France in 2011 (ELFE study, n=18,014). Maternal substance use in pregnancy (tobacco: ≥1 cigarette/day, alcohol: ≥1 time, binge drinking: ≥3 units of alcohol on one occasion) was assessed using survey methodology by a) trained interviewers and b) self-reports. Migration status was determined based on country of birth (native-born vs. migrant). The sample included 2330 migrant women, predominantly from North Africa (35.4% - primarily Algeria and Morocco), Sub-Saharan Africa (27.3% - primarily Senegal, Ivory Coast, the Congo and Cameroun), Europe (20.2% - primarily Portugal and Germany) and Asia (10.2% - primarily Turkey). Characteristics potentially associated with substance use included socio-demographics (maternal age, number of children, relationship status, educational attainment, employment status), health (psychological difficulties, incomplete prenatal care) and partner's characteristics (migration status, employment). RESULTS Compared to the native-born, migrant women had lower levels of tobacco smoking (8.8 vs. 21.9%) and alcohol use (23.4 vs. 40.7%), but not binge drinking (2.9 vs. 3.3%). Unfavorable socioeconomic circumstances were associated with tobacco smoking in native-born women only. Single parenthood was associated with alcohol use only in migrant women. In migrant women, co-occurring use of another substance and psychological difficulties were more strongly associated with use of tobacco, alcohol or binge drinking than in native-born women. CONCLUSIONS Migrant women have less favorable socioeconomic characteristics than native women but are generally less likely to use tobacco and alcohol in pregnancy. However those who experience single-parenthood need special attention, as they are disproportionately likely to use psychoactive substances which put them and their children at risk of poor health outcomes.
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Perinatal outcomes among migrant mothers in the United Kingdom: Is it a matter of biology, behaviour, policy, social determinants or access to health care? Best Pract Res Clin Obstet Gynaecol 2015; 32:39-49. [PMID: 26527304 DOI: 10.1016/j.bpobgyn.2015.09.003] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2015] [Revised: 09/22/2015] [Accepted: 09/22/2015] [Indexed: 11/21/2022]
Abstract
This paper examines trends in perinatal outcomes among migrant mothers in the UK, and it explores potential contributors to disparities focusing on pregnancy, birth and the first year of life. Trends in perinatal outcomes indicate that ethnic minority grouping, regardless of migrant status, is a significant risk factor for unfavourable outcomes. It is unclear whether migrant status per se adds to this risk as within-group comparisons between UK-born and foreign-born women show variable findings. The role of biological and behavioural factors in producing excess unfavourable outcomes among ethnic minority mothers, although indicated, is yet to be fully understood. UK policies have salient aspects that address ethnic inequalities, but their wide focus obscures provisions for migrant mothers. Direct associations between socio-economic factors, ethnicity and adverse infant outcomes are evident. Evidence is consistent about differential access to and utilisation of health services among ethnic minority mothers, in particular recently arrived migrants, refugees and asylum seekers.
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Epidemiology Data from the Scottish Health and Ethnicity Linkage Study (SHELS). OPEN HEALTH DATA 2014. [DOI: 10.5334/ohd.an] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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