Maternal and Child Health Journal

, Volume 16, Issue 3, pp 569–578 | Cite as

Risk and Protective Factors for Pregnancy Outcomes for Urban Aboriginal and Non-Aboriginal Mothers and Infants: The Gudaga Cohort

  • Elizabeth Comino
  • Jennifer Knight
  • Vana Webster
  • Lisa Jackson Pulver
  • Bin Jalaludin
  • Elizabeth Harris
  • Pippa Craig
  • Dennis McDermott
  • Richard Henry
  • Mark Harris
  • The Gudaga Research Team
Article

Abstract

This paper aims to describe delivery and birth outcomes of Aboriginal infants and their mothers in an urban setting on the east coast of Australia. The paper uses a causal pathway approach to consider the role of risk and protective factors for low birthweight. All mothers who delivered at Campbelltown Hospital between October 2005 and May 2007 were eligible. The study included 1,869 non-Aboriginal infants and 178 Aboriginal infants and their mothers. Information on delivery and birthweight was extracted from electronic medical records. Risk factors for poor outcomes were explored using regression and causal pathway analysis. Mothers of Aboriginal infants were younger than mothers of non-Aboriginal infants, and were more likely to be single, less educated, unemployed prior to pregnancy, and live in a disadvantaged neighbourhood. Health and service use was similar. They were significantly more likely to have a vaginal delivery than mothers of non-Aboriginal infants (77% cf 62.5%; χ 1 2  = 14.6, P < 0.001) and less likely to receive intervention during delivery. Aboriginal infants (3,281.1 g) weighed 137.5 g (95%CI: 54–221 g; P = 0.001) less then non-Aboriginal infants (3,418.7 g). Gestational age, and single mother with incomplete education, prior unemployment, smoking, and living in a disadvantaged neighbourhood were associated with lower birthweight. Maternal vulnerability had a cumulative impact on birthweight. A causal pathway analysis demonstrated the associations between risk factors.

Keywords

Indigenous Birth outcomes Risk factors Protective factors 

Notes

Acknowledgments

The Gudaga research team acknowledges the Tharawal people of south west Sydney. Without the cooperation and enthusiasm of these traditional land owners this research would not be possible. We thank the mothers who participate in this study for we could not undertake this research without their willingness to be involved. We would also like to acknowledge the support of Tharawal Aboriginal Corporation, Sydney South West Area Health Service, the University of New South Wales, and the NSW Aboriginal Health and Medical Research Council for ongoing support. This research was funded by a project grant from the National Health and Medical Research Council. Sydney South West Area Health Service (Campbelltown) provided infrastructure support to the project.

Conflict of interest

None.

References

  1. 1.
    Wenman, W., Joffres, M., & Tataryn, I. (2004). A prospective cohort study of pregnancy risk factors and birth outcomes in Aboriginal women. Canadian Medical Association Journal, 171, 585–589.PubMedCrossRefGoogle Scholar
  2. 2.
    Grossman, D. C., Krieger, J. W., Sugarman, J. R., & Forquera, R. A. (1994). Health status of urban American Indians and Alaska Natives. A population-based study. Journal of the American Medical Association, 271, 845–850.PubMedCrossRefGoogle Scholar
  3. 3.
    National Aboriginal Health Strategy Working Party. (1989). A national aboriginal health strategy. Canberra: National Aboriginal Health Strategy Working Party.Google Scholar
  4. 4.
    Leeds, K., Gourley, M., Laws, P., Zhang, J., Al-Yaman, F., & Sullivan, E. (2007). Indigenous mothers and their babies, Australia 2001–2004. Canberra: Australian Institute of Health and Welfare.Google Scholar
  5. 5.
    Johnston, T., & Coory, M. (2005). Reducing perinatal mortality among Indigenous babies in Queensland: should the first priority be better primary health care or better access to hospital care during confinement. Australian and New Zealand Health Policy, 2, 11.CrossRefGoogle Scholar
  6. 6.
    Sayers, S., & Powers, J. (1997). Risk factors for Aboriginal low birthweight, intrauterine growth retardation and preterm birth in the Darwin Health Region. Australia and New Zealand Journal of Public Health, 21, 524–530.CrossRefGoogle Scholar
  7. 7.
    Eades, S., Read, A. W., Stanley, F. J., Eades, F. N., McCaullay, D., & Williamson, A. (2008). Bibbulung Gnarneep (‘solid kid’): causal pathways to poor birth outcomes in an urban Aboriginal birth cohort. Journal of Paediatrics and Child Health, 44, 342–346.PubMedCrossRefGoogle Scholar
  8. 8.
    Titmuss, A. T., Harris, E., & Comino, E. J. (2008). The roles of socioeconomic status and aboriginality in birth outcomes at an urban hospital. Medical Journal of Australia, 189, 495–498.PubMedGoogle Scholar
  9. 9.
    Sayers, S. M., & Powers, J. R. (1993). Birth size of Australian Aboriginal babies. Medical Journal of Australia, 159, 586–591.PubMedGoogle Scholar
  10. 10.
    Humphrey, M., & Holzheimer, D. (2000). A prospective study of gestation and birthweight in Aboriginal pregnancies in far north Queensland. Australian and New Zealand Journal of Obstetrics and Gynaecology, 40, 326–330.PubMedCrossRefGoogle Scholar
  11. 11.
    Panaretto, K. S., Muller, R., Patole, S., Watson, D., & Whitehall, J. S. (2002). Is being Aboriginal or Torres Strait Islander a risk factor for poor neonatal outcome in a tertiary referral unit in north Queensland? Journal of Paediatrics and Child Health, 38, 16–22.PubMedCrossRefGoogle Scholar
  12. 12.
    Kieffer, E. C., Alexander, G. R., & Mor, J. M. (1995). Pregnancy outcomes of Pacific islanders in Hawaii. American Journal of Epidemiology, 141, 674–679.PubMedGoogle Scholar
  13. 13.
    Kieffer, E. C., Mor, J. M., & Alexander, G. R. (1994). The perinatal and infant health status of Native Hawaiians. American Journal of Public Health, 84, 1501–1504.PubMedCrossRefGoogle Scholar
  14. 14.
    Blair, E. (1996). Why do Aboriginal newborns weigh less? Determinants of birthweight for gestation. Journal of Paediatrics and Child Health, 32, 498–503.PubMedCrossRefGoogle Scholar
  15. 15.
    Coory, M. (2000). Trends in birth rates for teenagers in Queensland, 1988 to 1997: an analysis by economic disadvantage and geographic remoteness. Australian and New Zealand Journal of Public Health, 24, 316–319.PubMedCrossRefGoogle Scholar
  16. 16.
    Chan, A., Keane, R. J., & Robinson, J. S. (2001). The contribution of maternal smoking to preterm birth, small for gestational age and low birthweight among Aboriginal and non-Aboriginal births in South Australia. Medical Journal of Australia, 174, 389–393.PubMedGoogle Scholar
  17. 17.
    Jaddoe, V. W., Troe, E. J., Hofman, A., Mackenbach, J. P., Moll, H. A., Steegers, E. A., et al. (2008). Active and passive maternal smoking during pregnancy and the risks of low birthweight and preterm birth: the Generation R Study. Paediatric and Perinatal Epidemiology, 22, 162–171.PubMedCrossRefGoogle Scholar
  18. 18.
    Kieffer, E. C., Carman, W. J., Gillespie, B. W., Nolan, G. H., Worley, S. E., & Guzman, J. R. (2001). Obesity and gestational diabetes among African-American women and Latinas in Detroit: implications for disparities in women’s health. Journal of the American Medical Women’s Association, 56, 181–187.PubMedGoogle Scholar
  19. 19.
    Panaretto, K., Lee, H., Mitchell, M., Larkins, S., Manessis, V., Buettner, P., et al. (2006). Risk factors for preterm, low birth weight and small for gestational age birth in urban Aboriginal and Torres Strait Islander women in Townsville. Australian and New Zealand Journal of Public Health, 30, 163–170.PubMedCrossRefGoogle Scholar
  20. 20.
    Wilkinson, S. A., Miller, Y. D., & Watson, B. (2009). Prevalence of health behaviours in pregnancy at service entry in a Queensland health service district. Australian and New Zealand Journal of Public Health, 33, 228–233.PubMedCrossRefGoogle Scholar
  21. 21.
    Wills, R. A., & Coory, M. D. (2008). Effect of smoking among indigenous and non-indigenous mothers on preterm birth and full-term low birthweight. Medical Journal of Australia, 189, 490–494.PubMedGoogle Scholar
  22. 22.
    Stanley, F. J., Sanson, A., & McMichael, T. (2002). New ways of causal pathways thinking for public health. Canberra: Australian Institute of Family Studies.Google Scholar
  23. 23.
    Comino, E., Craig, P., Harris, E., McDermott, D., Harris, M., Henry, R., et al. (2010). The Gudaga Study: establishing an Aboriginal birth cohort in an urban community. Australian and New Zealand Journal of Public Health, 34, S9–S17.PubMedCrossRefGoogle Scholar
  24. 24.
    Centre for Epidemiology and Research. (2002). New South Wales Child Health Survey. Sydney: NSW Department of Health, Contract No.: S-4.Google Scholar
  25. 25.
    Ananth, C. V., Demissie, K., Kramer, M. S., & Vintzileos, A. M. (2003). Small-for-gestational-age births among black and white women: Temporal trends in the United States. American Journal of Public Health, 93, 577–579.PubMedCrossRefGoogle Scholar
  26. 26.
    Roberts, C., & Lancaster, P. A. L. (1999). Australian national birthweight percentiles by gestational age. Medical Journal of Australia, 170, 114–118.PubMedGoogle Scholar
  27. 27.
    Bronfenbrenner, U. (1977). Toward an experimental ecology of human development. American Psychologist, 32, 513–531.CrossRefGoogle Scholar
  28. 28.
    Australian Bureau of Statistics. (2006). Information paper: An introduction to Socio-Economic Indexes for Areas (SEIFA). Canberra: Australian Bureau of Statistics.Google Scholar
  29. 29.
    Kramer, M. S., Goulet, L., Lydon, J., Séguin, L., McNamara, H., Dassa, C., et al. (2001). Socio-economic disparities in preterm birth: Causal pathways and mechanisms. Paediatric and Perinatal Epidemiology, 15, 104–123.PubMedCrossRefGoogle Scholar
  30. 30.
    National Health and Medical Research Council. (2002). The NHMRC Roadmap: a strategic framework for improving Aboriginal and Torres Strait Islander health through research. Canberra: National Health and Medical Research Council.Google Scholar
  31. 31.
    National Health and Medical Research Council. (2003). Values and ethics: guidelines for ethical conduct in Aboriginal and Torres Strait Islander health research. Canberra: National Health and Medical Research Council.Google Scholar
  32. 32.
    Knight, J., Comino, E., Harris, E., Jackson Pulver, L., & Craig, P. (2009). Indigenous research: a commitment to walking the talk: The Gudaga Study: an Australian case study. Journal of Bioethical Inquiry, 6, 467–476.CrossRefGoogle Scholar
  33. 33.
    Secretariat of National Aboriginal and Islander Child Care. (2010). 35 Children and Family Centres. What’s happening across the nation? Retrived on June 1, 2010, from: http://www.snaicc.asn.au/news/view_article.cfm?id=261&loadref=8.
  34. 34.
    Taylor, L. K., & Mahoney, R. (2006). Quality of reporting of aboriginality to the NSW midwives data collection. Australasian Epidemiologists, 1, 15–17.Google Scholar

Copyright information

© Springer Science+Business Media, LLC 2011

Authors and Affiliations

  • Elizabeth Comino
    • 1
  • Jennifer Knight
    • 1
  • Vana Webster
    • 1
  • Lisa Jackson Pulver
    • 2
  • Bin Jalaludin
    • 3
  • Elizabeth Harris
    • 1
  • Pippa Craig
    • 4
  • Dennis McDermott
    • 5
  • Richard Henry
    • 6
  • Mark Harris
    • 1
  • The Gudaga Research Team
  1. 1.Centre for Primary Health Care and Equity, Faculty of MedicineUniversity of New South WalesSydneyAustralia
  2. 2.Muru Marri Indigenous Health Unit, School of Public Health and Community MedicineUniversity of New South WalesSydneyAustralia
  3. 3.Centre for Research, Evidence Management and SurveillanceClinical Support Cluster West, NSW HealthLiverpoolAustralia
  4. 4.School of Public Health and Community MedicineUniversity of New South WalesSydneyAustralia
  5. 5.Flinders Prevention, Promotion and Primary Health CareFlinders UniversityBedford ParkAustralia
  6. 6.Division of the Deputy Vice–Chancellor (Academic)University of New South WalesSydneyAustralia

Personalised recommendations