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PP.21 The Effect of Factors of Social Exclusion on Access to Antenatal Care and the Subsequent Impact on Fetal Outcomes
  1. EM Mercer,
  2. DOC Anumba
  1. University of Sheffield, Sheffield, UK

Abstract

Background Delayed access to antenatal care is linked to maternal deaths and morbidity. Social deprivation also accounts for much maternal and child ill-health, with national health data showing discrepancies in the access and utilisation of care by groups of women who differ by ethnicity, age and socioeconomic status.

Objectives To map the prevalence of social deprivation and delayed access to antenatal care amongst women attending a regional referral maternity service and to correlate with fetal outcomes.

Methods Retrospectively analysed data collected from 59,847 singleton births at the Jessop Wing Hospital, Sheffield, UK, between 2002 and 2010, identifying maternal demographic features and neonatal outcomes. We plotted the Index of Multiple Deprivation (IMD) scores of women against the distribution of delayed access to antenatal care.

Results The geographic distribution of high deprivation scores and first pregnancy care attendance after 20 weeks gestation matched closely. High IMD scores increased the risk of being a late booker (OR: 1.092, 95% CI: 1.01–1.18, p = 0.031) and being of minority ethnic extraction (OR: 5.6, 95% CI: 5.2–5.9, p < 0.001), and significantly predicted low birth weight (OR: 1.66, 95% CI: 1.31–2.12, p < 0.001), premature delivery (OR:1.34, 95% CI: 1.06–1.70, p = 0.017) and stillbirth (OR: 2.25, 95% CI: 1.68–3.01, p < 0.001). When sociodemographic variables were adjusted for, late booking did not independently predict adverse maternal or fetal outcomes.

Conclusions Disparities remain for women from certain backgrounds. Geographic mapping of high deprivation scores can direct research and health delivery strategies seeking to promote better access to pregnancy care and mitigate the resulting adverse fetal outcomes.

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