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Understanding socioeconomic inequalities in outcome of pregnancy and neonatal mortality associated with congenital anomalies
  1. L K Smith,
  2. J L S Budd,
  3. D J Field,
  4. E S Draper
  1. University of Leicester, Leicester, UK

Abstract

Aims To investigate socioeconomic inequalities in outcome of pregnancy and neonatal mortality associated with congenital anomalies.

Methods Population-based registry study of 581 597 total births to mothers resident in the East Midlands and South Yorkshire regions of England 1998–2007. Outcome measures were socioeconomic variation in risk of congenital anomalies; pregnancy outcome; live birth incidence and neonatal mortality. Nine anomalies audited as part of the UK Fetal Anomaly Screening Programme were included. Deprivation measured using the Index of Multiple Deprivation 2004.

Results There were 1579 fetuses with one or more selected anomalies. There was no evidence of variation in the risk of anomalies with deprivation (rate ratio comparing the most deprived with the least deprived decile: 1.05 (0.89, 1.23)). 86% of anomalies were detected antenatally and there was no evidence that this varied with deprivation (rate ratio 0.99 (0.84, 1.17)). However fetuses from the most deprived decile diagnosed with an anomaly in the antenatal period were significantly less likely to be terminated than those from the least deprived areas (rate ratio 0.79 (0.65, 0.97)). Consequently there was a wide deprivation gap in the rate of live births with an anomaly (rate Ratio:1.61 (1.21, 2.15)) and neonatal mortality (rate ratio:1.97 (1.20, 3.27)).

Conclusions Screening for congenital anomaly has reduced neonatal mortality through termination of pregnancy. However, socioeconomic variation in termination of pregnancy for fetal anomaly has resulted in a wide deprivation gap in live born infants with a congenital anomaly and subsequent neonatal mortality.

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