The Relationship between Social Determinants of Health and Pregnancy Outcomes: A Retrospective Cohort Study in Tabriz
Purpose: To assess the effects of social determinants of health on pregnancy outcome in rural and urban areas of Tabriz.
Methods: A retrospective cohort study design was used to examine 600 pregnant women who attended antenatal health care services in Tabriz, Iran from August 2012 to the October 2013. They were followed up from the sixth week of gestation to three months after delivery. Socioeconomic indicators and some other measures such as body mass index, family income status, maternal education and occupation, cigarette smoking, depression, intimate partner violence based upon health ministry guidelines and pregnancy outcomes including low birth weight, small for gestational, and preterm delivery, cesarean delivery and miscarriage were assessed .
Results: The mean age of women was 26.1 ± 6.6 years in rural and 27.9 ± 5.7 years in urban areas and the mean duration of pregnancy was 39.03± 1.36 weeks. There was a significant association between maternal education, cesarean section and abortion. BMI played a major role on almost all poor pregnancy outcomes (LBW, PTB, cesarean section, miscarriage) and income status was the first predictor of low birth weight. Socio demographic and behavioral factors were particularly important for predicting miscarriage, preterm labor and low birth weight.
Conclusion: Although residential area (rural versus urban of Tabriz) was associated with preterm labor, low birth weight and cesarean section , only cesarean section had a significant effect after adjusting for confounding factors such as income and education level, age, parity, obstetrical complications .Disparity in distribution of resources in rural and urban area were the main factors that made the pregnancy complicated in our study.