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A Comprehensive Review on Social Inequalities and Pregnancy Outcome—Identification of Relevant Pathways and Mechanisms

Author

Listed:
  • Valentin Simoncic

    (LIVE UMR 7362 CNRS (Laboratoire Image Ville Environnement), University of Strasbourg, 67100 Strasbourg, France)

  • Séverine Deguen

    (Equipe PHARes Population Health Translational Research, Inserm CIC 1401, Bordeaux Population Health Research Center, University of Bordeaux, 33076 Boedeaux, France)

  • Christophe Enaux

    (LIVE UMR 7362 CNRS (Laboratoire Image Ville Environnement), University of Strasbourg, 67100 Strasbourg, France)

  • Stéphanie Vandentorren

    (Equipe PHARes Population Health Translational Research, Inserm CIC 1401, Bordeaux Population Health Research Center, University of Bordeaux, 33076 Boedeaux, France
    Santé Publique France, French National Public Health Agency, 94410 Saint-Maurice, France)

  • Wahida Kihal-Talantikite

    (LIVE UMR 7362 CNRS (Laboratoire Image Ville Environnement), University of Strasbourg, 67100 Strasbourg, France)

Abstract

Scientific literature tends to support the idea that the pregnancy and health status of fetuses and newborns can be affected by maternal, parental, and contextual characteristics. In addition, a growing body of evidence reports that social determinants, measured at individual and/or aggregated level(s), play a crucial role in fetal and newborn health. Numerous studies have found social factors (including maternal age and education, marital status, pregnancy intention, and socioeconomic status) to be linked to poor birth outcomes. Several have also suggested that beyond individual and contextual social characteristics, living environment and conditions (or “neighborhood”) emerge as important determinants in health inequalities, particularly for pregnant women. Using a comprehensive review, we present a conceptual framework based on the work of both the Commission on Social Determinants of Health and the World Health Organization (WHO), aimed at describing the various pathways through which social characteristics can affect both pregnancy and fetal health, with a focus on the structural social determinants (such as socioeconomic and political context) that influence social position, as well as on intermediary determinants. We also suggest that social position may influence more specific intermediary health determinants; individuals may, on the basis of their social position, experience differences in environmental exposure and vulnerability to health-compromising living conditions. Our model highlights the fact that adverse birth outcomes, which inevitably lead to health inequity, may, in turn, affect the individual social position. In order to address both the inequalities that begin in utero and the disparities observed at birth, it is important for interventions to target various unhealthy behaviors and psychosocial conditions in early pregnancy. Health policy must, then, support: (i) midwifery availability and accessibility and (ii) enhanced multidisciplinary support for deprived pregnant women.

Suggested Citation

  • Valentin Simoncic & Séverine Deguen & Christophe Enaux & Stéphanie Vandentorren & Wahida Kihal-Talantikite, 2022. "A Comprehensive Review on Social Inequalities and Pregnancy Outcome—Identification of Relevant Pathways and Mechanisms," IJERPH, MDPI, vol. 19(24), pages 1-43, December.
  • Handle: RePEc:gam:jijerp:v:19:y:2022:i:24:p:16592-:d:999336
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    References listed on IDEAS

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