(177) Social inequalities in perinatal health: association between markers of social deprivation and preterm delivery

Context
Maternal exposure to unfavorable social conditions is associated with an increase in perinatal complications, such as placental vascular pathologies. An increased risk of preterm delivery has also been described, but its importance varies according to the studies and settings, suggesting different mechanisms.

Objective
To assess the association between maternal social deprivation and preterm delivery, overall and according to its mechanisms.

Study Design: This analysis of the PreCARE prospective cohort included 9365 patients who delivered singletons > 22 weeks. Maternal social deprivation was defined according to 4 variables analyzed separately and within a social deprivation index (coded from 0 to 3). The primary outcome was preterm delivery < 37 weeks. The association between social deprivation and prematurity was analyzed using uni- and multivariable logistic regression models. In a second analysis, we focused on the mechanism leading to preterm delivery according to 3 categories: spontaneous labor, preterm premature rupture of membranes (PPROM), and placental vascular pathology, using multinomial analysis.

Results:

At least one criterion of social deprivation was presented by 33% of the patients: 4.7% social isolation, 15.6% no work-related household income, 15.6% insecure housing situation and 22.4% no standard health insurance. Preterm delivery complicated 7% of pregnancies (39.8% spontaneous labor, 28.3% PPROM, 21.8% placental vascular pathologies and 10.1% others). In both univariable and multivariable analysis, there was no association between social deprivation and the risk of preterm delivery overall (Index of deprivation 1 vs 0, aOR=1.03 IC95% [0.83-1.28], 2 vs 0: aOR=1.05 IC95% [0.77-1.40], 3 vs 0: aOR=0.92 IC95% [0.66-1.31]) or according to its mechanisms.

Conclusion:

Contrary to results reported in other contexts, we did not observe any associations between different markers of social deprivation and the risk of preterm delivery, whatever its mechanism. These results raise hypotheses about the mechanisms of social inequalities in perinatal health.