The effect of neighbourhood income and deprivation on pregnancy outcomes in Amsterdam, The Netherlands

• Published in: Journal of epidemiology and community health (1979) Vol. 63; no. 9; pp. 755 - 760
• Main Authors: Agyemang, C, Vrijkotte, T G M, Droomers, M, van der Wal, M F, Bonsel, G J, Stronks, K
• Format: Journal Article
• Language: English
• Published: London BMJ Publishing Group Ltd 01.09.2009; BMJ Publishing Group; BMJ Publishing Group LTD
• Subjects: Abortion, Spontaneous - epidemiology; Adult; Biological and medical sciences; Birth weight; Community health; Country of birth; Education; Ethnicity; Female; Fetuses; General aspects; Gestational age; Humans; Hypertension; Hypertension, Pregnancy-Induced - epidemiology; Income effect; Infant, Newborn; Infant, Small for Gestational Age; Maternal Welfare - statistics & numerical data; Medical sciences; Middle Aged; Miscarriage; Miscellaneous; Multiple births; Neighborhoods; Netherlands - epidemiology; Obstetrics; Odds Ratio; Permanent income hypothesis; Pregnancy; Pregnancy induced hypertension; Pregnancy outcome; Pregnancy Outcome - epidemiology; Premature birth; Public health; Public health. Hygiene; Public health. Hygiene-occupational medicine; Questionnaires; Research reports; Residence Characteristics - statistics & numerical data; Risk Factors; Socioeconomic Factors; Socioeconomic status; Socioeconomics; Urban Health; Variables; Womens health; Young Adult; Netherlands; Europe; Social environment; Human; Social influence; Poverty; Prognosis; Income; Residential neighborhoods; Pregnancy; Medicine; Evolution; Female; Woman; Public health; Inequality; Neighbourhood income; Preterm birth; Small for gestational age; Pregnancy induced hypertension; PREGNANCY
• ISSN: 0143-005X; 1470-2738
• DOI: 10.1136/jech.2008.080408

Background: Studies suggest that the neighbourhoods in which people live influence their health. The main objective of this study was to investigate the associations of neighbourhood-level income and unemployment/social security benefit on pregnancy outcomes: preterm delivery, small for gestational age (SGA), pregnancy-induced hypertension (PIH) and miscarriage/perinatal death in Amsterdam. Methods: A random sample of 7883 from 82 neighbourhoods in Amsterdam. Individual-level data from the Amsterdam Born Children and their Development (ABCD) study were linked to data on neighbourhood-level factors. Multilevel logistic regression was used to estimate odds ratios and neighbourhood-level variance. Results: After adjustment for individual-level factors, women living in low-income neighbourhoods (third, second and first quartiles) were more likely than women living in high-income neighbourhoods (fourth quartile) to have SGA births: OR 1.32 (95% CI 1.04 to 1.68), 1.42 (1.11 to 1.82) and 1.62 (1.25 to 2.08) respectively. Women living in the quartile of neighbourhoods with the highest unemployment/social security benefit were more likely than those living in the quartile with the lowest unemployment/social security benefit to have SGA births 1.36 (1.08 to 1.72). The neighbourhood-level variance was significant only for SGA births. No significant associations were found between neighbourhood-level factors and other pregnancy outcomes. Conclusion: The findings suggest that neighbourhood income and deprivation are related to SGA births. More research is needed to explore possible mechanisms underlying poor neighbourhood environment and pregnancy outcomes, in particular through stress mechanisms. Such information might be necessary to help improve maternal and fetal health.