Abstract
Objective
To assess and compare the associations between household socioeconomic (SES) factors with birth outcomes (low birth weight (LBW), small-for-gestational age (SGA) and preterm birth (PTB)) in the Democratic Republic of Congo (DRC) and South Africa (SA).
Methods
Cross-sectional data of mother-newborn pairs collected in 2017 in the DRC were compared with mother-newborn pairs data from the SA Soweto first 1000-days pregnancy cohort study (2013–2016). Country-specific and pooled multivariable logistic regressions analyses assessed the associations between maternal education, marital status, and housing with LBW, SGA, and PTB adjusted for maternal anthropometry and obstetric factors.
Results
1084 mother-newborn pairs were recruited (DRC: 256; SA: 828). The rates of LBW, PTB and SGA were, 11.5%, 17.1% and 32.8% in the DRC and 15.9%, 10.5% and 20.1% in SA. SES factors differed between countries and sex. In the DRC, being married decreased the odds of having LBW and PTB children by 86% and 80%, respectively. In SA, being a mother with secondary level of education and above was associated with 86% reduced odds of SGA. In the pooled analyses, women with secondary level of education and above had a 2.2-fold increase in odds of giving birth to a PTB newborn. Country of residence and maternal nutritional status were stronger predictors of birth outcomes than SES factors.
Conclusion for Practice
In sub-Saharan Africa, policies aiming to alleviate women’s education combined with improved social support and household SES prior to and during pregnancy are critical to optimal neonatal outcomes and strategic to achieve the Sustainable Development Goals.
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References
Ayad, M., Piani, A. L., Barrere, B., Ekouevi, K., & Otto, J. (1994). Demographic characteristics of households DHS Comparative Studies No. 14. Macro International.
Black, R. E., Victora, C. G., Walker, S. P., Bhutta, Z. A., Christian, P., de Onis, M., et al. (2013). Maternal and child undernutrition and overweight in low-income and middle-income countries. Lancet, 382(9890), 427–451. https://doi.org/10.1016/s0140-6736(13)60937-x
Blencowe, H., Krasevec, J., de Onis, M., Black, R. E., An, X., Stevens, G. A., et al. (2019). National, regional, and worldwide estimates of low birthweight in 2015, with trends from 2000: A systematic analysis. The Lancet Global Health, 7(7), e849–e860. https://doi.org/10.1016/S2214-109X(18)30565-5
Campbell, M., Cartier, S., Xie, B., Kouniakis, G., Huang, W., & Han, V. (2012). Determinants of small for gestational age birth at term. Paediatric and Perinatal Epidemiology, 26(6), 525–533. https://doi.org/10.1111/j.1365-3016.2012.01319.x
Campbell, E. E., Jason, G., Paula, D. N. D., Barbra, D. V., Debbie, P., & Seabrook, J. A. (2018). Socioeconomic status and adverse birth outcomes: A population-based Canadian sample. Journal of Biosocial Science, 50(1), 102–113. https://doi.org/10.1017/s0021932017000062
Cantarutti, A., Franchi, M., Monzio, C. M., Merlino, L., & Corrao, G. (2017). Mother’s education and the risk of several neonatal outcomes: An evidence from an Italian population-based study. BMC Pregnancy and Childbirth, 17(1), 221. https://doi.org/10.1186/s12884-017-1418-1
Chawanpaiboon, S., Vogel, J. P., Moller, A. B., Lumbiganon, P., Petzold, M., Hogan, D., et al. (2018). Global, regional, and national estimates of levels of preterm birth in 2014: A systematic review and modelling analysis. The Lancet, 7(1), 10. https://doi.org/10.1016/S2214-109X(18)30451-0
Chen, J.-H. (2012). Maternal alcohol use during pregnancy, birth weight and early behavioral outcomes. Alcohol and Alcoholism, 47(6), 649–656. https://doi.org/10.1093/alcalc/ags089
Chia, A., Chen, L., Lai, J., Wong, C., Neelakantan, N., Van Dam, R., et al. (2019). Maternal dietary patterns and birth outcomes: A systematic review and meta-analysis. Advances in Nutrition, 10(4), 685–695. https://doi.org/10.1093/advances/nmy123
Faucher, M., Hastings-Tolsma, M., Song, J., Willoughby, D., & Bader, S. (2016). Gestational weight gain and preterm birth in obese women: A systematic review and meta-analysis. BJOG, 123(2), 199–206. https://doi.org/10.1111/1471-0528.13797
Fraser, D., & Abu-Saad, K. (2010). Maternal nutrition and birth outcomes. Epidemiologic Reviews, 32(1), 5–25. https://doi.org/10.1093/epirev/mxq001
Goldstein, R., Abell, S., Ranasinha, S., Misso, M., Boyle, J., Black, M., et al. (2017). Association of gestational weight gain with maternal and infant outcomes: A systematic review and meta-analysis. JAMA, 317(21), 2207–2225. https://doi.org/10.1001/jama.2017.3635
Han, Z., Mulla, S., Beyene, J., Liao, G., & McDonald, S. D. (2011). Maternal underweight and the risk of preterm birth and low birth weight: A systematic review and meta-analyses. International Journal of Epidemiology, 40(1), 65–101. https://doi.org/10.1093/ije/dyq195
Hoffman, C. S., Messer, L. C., Mendola, P., Savitz, D. A., Herring, A. H., & Hartmann, K. E. (2008). Comparison of gestational age at birth based on last menstrual period and ultrasound during the first trimester. Paediatric and Perinatal Epidemiology, 22(6), 587–596. https://doi.org/10.1111/j.1365-3016.2008.00965.x
Lee Anne, C., Kozuki, N., Cousens, S., Stevens, G. A., Blencowe, H., Silveira, M. F., et al. (2017). Estimates of burden and consequences of infants born small for gestational age in low and middle income countries with INTERGROWTH-21st standard: Analysis of CHERG datasets. BMJ. https://doi.org/10.1136/bmj.j3677
Lekea-Karanika, V., Tzoumaka-Bakoula, C., & Matsaniotis, N. S. (1999). Sociodemographic determinants of low birthweight in Greece: A population study. Paediatric and Perinatal Epidemiology, 13(1), 65–77.
Luo, Z.-C., Wilkins, R., & Kramer, M. S. (2006). Effect of neighbourhood income and maternal education on birth outcomes: A population-based study. Canadian Medical Association Journal, 174(10), 1415. https://doi.org/10.1503/cmaj.051096
Macaulay, S., Munthali, R. J., Dunger, D. B., & Norris, S. A. (2018). The effects of gestational diabetes mellitus on fetal growth and neonatal birth measures in an African cohort. Diabetic Medicine, 35(10), 1425–1433. https://doi.org/10.1111/dme.13668
McDonald, S. D., Han, Z., Mulla, S., Lutsiv, O., Lee, T., Beyene, J., et al. (2011). High gestational weight gain and the risk of preterm birth and low birth weight: A systematic review and meta-analysis. Journal of Obstetrics and Gynaecology Canada, 33(12), 1223–1233. https://doi.org/10.1016/s1701-2163(16)35107-6
Momplaisir, F., Brady, K., Fekete, T., Thompson, D., Diez Roux, A., & Yehia, B. (2015). Time of HIV diagnosis and engagement in prenatal care impact virologic outcomes of pregnant women with HIV. PLoS ONE, 10(7), e0132262. https://doi.org/10.1371/journal.pone.0132262
Muula, A., Siziya, S., & Rudatsikira, E. (2011). Parity and maternal education are associated with low birth weight in Malawi. African Health Science, 11, 65–71.
Ngandu, C., Momberg, D., Magan, A., Lumbwe, C., Norris, A. S., & Said-Mohamed, R. (2019). The association between household socioeconomic status, maternal socio-demographic characteristics and adverse birth and infant growth outcomes in sub-Saharan Africa: A systematic review. Journal of Developmental Origins of Health and Disease. https://doi.org/10.1017/S2040174419000680
Raatikainen, K., Heiskanen, N., & Heinonen, S. (2007). Under-attending free antenatal care is associated with adverse pregnancy outcomes. BMC Public Health, 7(1), 268. https://doi.org/10.1186/1471-2458-7-268
Shah, P., & Shah, J. (2010). Maternal exposure to domestic violence and pregnancy and birth outcomes: A systematic review and meta-analyses. Journal of Women’s Health (2002), 19(11), 2017–2031. https://doi.org/10.1089/jwh.2010.2051
Silvestrin, S., Silva, C. H., Hirakata, V. N., Goldani, A. A., Silveira, P. P., & Goldani, M. Z. (2013). Maternal education level and low birth weight: A meta-analysis. Journal de Pediatria, 89(4), 339–345. https://doi.org/10.1016/j.jped.2013.01.003
UNICEF, & WHO. (2019). Low birthweight estimations: Levels and trends 2000–2015. https://www.who.int/nutrition/publications/UNICEF-WHO-lowbirthweight-estimates-2019/en/, 36.
UNICEF, WHO, & WBG. (2019). Levels and trends in child malnutrition. Key findings of the 2019 edition. WHO edition. https://www.who.int/nutgrowthdb/estimates2018/en/(19), 16.
Vatten, L. J., & Skjaerven, R. (2003). Effects on pregnancy outcome of changing partner between first two births: Prospective population study. BMJ, 327(7424), 1138. https://doi.org/10.1136/bmj.327.7424.1138
Victora, C. G., Adair, L., Fall, C., Hallal, P. C., Martorell, R., Richter, L., et al. (2008). Maternal and child undernutrition: Consequences for adult health and human capital. The Lancet, 371(9609), 340–357. https://doi.org/10.1016/S0140-6736(07)61692-4
WHO. (2008). Training course on child growth assessment. WHO child growth standards. Measuring a child's growth. https://www.who.int/nutrition/publications/childgrowthstandards_trainingcourse/en/
WHO. (2014). Global nutrition targets 2025: low birth weight policy brief Geneva.
WHO. (2016). WHO recommendations on antenatal care for a positive pregnancy experience. WHO edition. https://www.ncbi.nlm.nih.gov/books/NBK409110/
WHO. (2018). World Health Organization housing and health Guidelines. WHO edition. https://www.who.int/sustainable-development/publications/housing-health-guidelines/en/
Wilding, S., Ziauddeen, N., Roderick, P., Smith, D., Chase, D., Macklon, N., et al. (2019). Are socioeconomic inequalities in the incidence of small-for-gestational-age birth narrowing? Findings from a population-based cohort in the South of England. British Medical Journal Open, 9(7), e026998. https://doi.org/10.1136/bmjopen-2018-026998
World Bank. (2019). Human development index. World Development Indicators. South Africa and Democratic Republic of Congo databases. The World Bank Group. http://worldpopulationreview.com/countries/hdi-by-country/
Wrottesley, S. V., Pisa, P. T., & Norris, S. A. (2017). The influence of maternal dietary patterns on body mass index and gestational weight gain in urban black South African women. Nutrients, 9(7), 732.
Acknowledgements
We wish to thank participants and staff that helped us during the data collection period.
Funding
This study was made possible through the support of the South African Medical Research Council by the Department of Science and Technology and the National Research Foundation (DST-NRF) for the Centre of Excellence in Human Development (SAN and RSM., Grant Number: ACC2017007) and by the DST-NRF for the Centre of Excellence in Food Security (DM and RSM, Grant Number: 160502).
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Conceptualization of the study: NBC, SAN, RSM; Data management, analyses and interpretation: NBC, DM, SAN; RSM. Integrity of data: CBN; RSM. Editing manuscript: AM. Writing and updating manuscript: CBN, DM, AM, SAN, RSM.
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Ngandu, C.B., Momberg, D., Magan, A. et al. Association Between Household and Maternal Socioeconomic Factors with Birth Outcomes in the Democratic Republic of Congo and South Africa: A Comparative Study. Matern Child Health J 25, 1296–1304 (2021). https://doi.org/10.1007/s10995-021-03147-x
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DOI: https://doi.org/10.1007/s10995-021-03147-x