Perinatal Health in Scotland
Based on the analysis of routine hospital data and the registrations of 1.3 million births in Scotland from 1980 to 2000, this project has considered the trends in perinatal events and their determinants in Scotland, with a particular focus on inequalities.
Inequalities in Caesarean section rates
Caesarean section rates have risen over the last 20 years in the UK. Previous work suggested that the odds of having an elective Caesarean section were lowest in the most deprived areas of England compared with the most affluent, but that study used area deprivation as a marker of socio-economic status rather than individual occupational social class. We examined whether individual social class or area deprivation or both are related to Caesarean sections in Scotland and investiged changes over time. We found the pattern of Caesarean sections in Scotland changed significantly between 1981 and 2000, as did the link between Caesarean section, mother’s social class and level of deprivation of the area of residence. Advantaged mothers in Scotland in 2000 were more likely to have their babies by planned section than mothers living in poorer circumstances; and both individual social class and area deprivation were independently associated with sections. Emergency Caesarean sections were equally distributed across the social spectrum.
Other work compared trends in caesarean section rates in former communist (transition) countries and other European countries. We found that Caesarean section rates have risen more rapidly in European countries in transition compared to other European countries raising questions regarding the appropriateness of spending on maternity care.
Inequalities in perinatal outcomes
Parental occupational social class is associated with adverse perinatal outcomes. Social class is also related to other maternal factors such as marital status, age and height. The interactions between social class and other maternal factors, and the changing distributions of these risk factors, create problems for assessing social inequalities. We investigated the relationships between social class and other maternal risk factors over time to identify those groups of women among whom inequalities in adverse perinatal outcomes were greatest and those groups that have contributed to the increase in inequality in these outcomes observed in 1990s. We considered low birthweight, preterm births and small-for-gestational age as outcomes. Our measure of inequality - the relative index of inequality (RII) - decreased during the 1980s for all outcomes and then increased between the early and late 1990s. Inequalities were greatest in married mothers, mothers aged over 35, mothers taller than 164cm, and mothers with a parity of one or more. Inequalities were also greater by the end of the 1990s than at the start of the 1980s for women of parity one or more and for mothers who were not married. Despite decreasing during the 1980s, inequalities in adverse perinatal outcomes increased during the 1990s in all strata defined by maternal characteristics.
Changing patterns of birthweight in Scotland
Birthweight is used as an indicator of both individual and population health with low birthweight being associated with poorer fetal development and poor health. It is one of the main determinants of perinatal and infant death, and has strong associations with both child and adult health. We analysed 1.3 million birth records from routinely collected maternity discharge data in Scotland between 1980 and 2000 to look at birthweight trends and the changes in the distribution of maternal risk factors for birthweight. We examined the contributions of each of the risk factors to birthweight trends and looked to see if there had been a reduction in inequality in birthweight over time. Both mean birthweight and low birthweight (LBW: <2,500g) were studied as outcomes. Mean birthweight increased from 3,320g in 1980 to 3,410g in 2000, while the percentage LBW decreased slightly from 5.7% in 1980 to 5.4% in 2000. The prevalence of many risk factors changed: there had been an increase in the proportion of older mothers, single mothers, taller mothers and mothers with undetermined social class. Although most risk factors had a significant change in effect over time, the inequalities in birthweight between social class groups did not diminish.
Fairley L, Dundas R, Leyland AH. The influence of both individual and area based socioeconomic status on temporal trends in Caesarean sections in Scotland 1980-2000. BMC Public Health 2011;11:330pubmed open access
Fairley L, Leyland AH. Social class inequalities in perinatal outcomes: Scotland 1980-2000. Journal of Epidemiology & Community Health 2006;60:31-36pubmed
Fairley L. Changing patterns of inequality in birthweight and its determinants: a population-based study, Scotland 1980-2000. Paediatric and Perinatal Epidemiology 2005;19:342-350pubmed