Individual accumulation of heterogeneous risks explains perinatal inequalities within deprived neighbourhoods

Dutch’ figures on perinatal mortality and morbidity are poor compared to EU-standards. Considerable within-country differences have been reported too, with decreased perinatal health in deprived urban areas. We investigated associations between perinatal risk factors and adverse perinatal outcomes in 7,359 pregnant women participating in population-based prospective cohort study, to establish the independent role, if any, for living within a deprived urban neighbourhood. Main outcome measures included perinatal death, intrauterine growth restriction (IUGR), prematurity, congenital malformations, Apgar at 5 min\7, and pre-eclampsia. Information regarding individual risk factors was obtained from questionnaires, physical examinations, ultrasounds, biological samples, and medical records. The dichotomous Dutch deprivation indicator was additionally used to test for unexplained deprived urban area effects. Pregnancies from a deprived neighbourhood had an increased risk for perinatal death (RR 1.8, 95% CI [1.1; 3.1]). IUGR, prematurity, Apgar at 5 min\7, and pre-eclampsia also showed higher prevalences (P\0.05). Residing within a deprived neighbourhood was associated with increased prevalence of all measured risk factors. Regression analysis showed that the observed neighbourhood related differences in perinatal outcomes could be attributed to the increased risk factor prevalence only, without a separated role for living within a deprived neighbourhood. Women from a deprived neighbourhood had significantly more ‘possibly avoidable’ risk factors. To conclude, women from a socioeconomically deprived neighbourhood are at an increased risk for adverse S. Timmermans  V. W. V. Jaddoe The Generation R Study Group, Erasmus MC Rotterdam, POB 2040, 3000 CA Rotterdam, The Netherlands S. Timmermans (&)  G. J. Bonsel  R. P. M. Steegers-Theunissen  E. Birnie  E. A. P. Steegers Department of Obstetrics and Gynaecology, Erasmus MC, University Medical Centre Rotterdam, POB 2040, 3000 CA Rotterdam, The Netherlands e-mail: s.timmermans@erasmusmc.nl R. P. M. Steegers-Theunissen  H. W. Tiemeier  A. Hofman  V. W. V. Jaddoe Department of Epidemiology, Erasmus MC Rotterdam, POB 2040, 3000 CA Rotterdam, The Netherlands R. P. M. Steegers-Theunissen  V. W. V. Jaddoe Department of Paediatrics, Erasmus MC Rotterdam, POB 2040, 3000 CA Rotterdam, The Netherlands R. P. M. Steegers-Theunissen Department of Clinical Genetics, Erasmus MC Rotterdam, POB 2040, 3000 CA Rotterdam, The Netherlands J. P. Mackenbach  E. W. Steyerberg  H. Raat  C. W. N. Looman Department of Public Health, Erasmus MC Rotterdam, POB 2040, 3000 CA Rotterdam, The Netherlands H. A. Verbrugh Department of Medical Microbiology and Infectious Diseases, Erasmus MC Rotterdam, POB 2040, 3000 CA Rotterdam, The Netherlands H. W. Tiemeier Department of Child and Adolescent Psychiatry, Erasmus MC Rotterdam, POB 2040, 3000 CA Rotterdam, The Netherlands E. Birnie Institute of Health Policies and Management, Erasmus University Rotterdam, POB 1738, 3000 DR Rotterdam, The Netherlands 123 Eur J Epidemiol (2011) 26:165–180 DOI 10.1007/s10654-010-9542-5 pregnancy outcomes. Differences regarding possibly avoidable risk factors imply that preventive strategies may prove effective.