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Socioeconomic inequalities in pregnancy outcome associated with Down Syndrome: a population based study

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journal contribution
posted on 07.05.2015, 10:00 by Judith L. S. Budd, Elizabeth S. Draper, Robyn R. Lotto, Laura E. Berry, Lucy K. Smith
Objective: To investigate socioeconomic inequalities in outcome of pregnancy associated with Down syndrome (DS) compared with other congenital anomalies screened for during pregnancy. Design & Setting: Retrospective population-based registry study (East Midlands & South Yorkshire in England). Participants: All registered cases of DS and nine selected congenital anomalies with poor prognostic outcome (FASP9) with an end of pregnancy date between 1 January 1998 and 31 December 2007. Main outcome measures: Poisson regression models were used to explore outcome measures including: socioeconomic variation in rates of anomaly; antenatal detection; pregnancy outcome; live birth incidence; and neonatal mortality. Deprivation was measured using the Index of Multiple Deprivation 2004 at super output area level. Results: There were 1151 cases of DS and 1572 cases of the nine severe anomalies combined. The overall rate of antenatal detection was 57% for DS, which decreased with increasing deprivation (Rate ratio comparing the most deprived tenth with the least deprived: 0.76 (0.60 to 0.97)). Antenatal detection rates were considerably higher for FASP9 anomalies (86%), with no evidence of a trend with deprivation (0.99 95% CI (0.84 to 1.17)). The termination of pregnancy rate following antenatal diagnosis was higher for Down syndrome (86%) than the FASP9 anomalies (70%). Both groups showed wide socioeconomic variation in the termination of pregnancy rate (Rate ratio: DS: 0.76, (0.58 to 0.99); FASP9 anomalies: 0.80 (0.65 to 0.97)). Consequently, socioeconomic inequalities in live birth and neonatal mortality rates associated with these anomalies arise that were not observed in utero. Conclusions: Socioeconomic inequalities exist in the antenatal detection of DS, and subsequent termination rates are much higher for DS than other anomalies. Termination rates for all anomalies are lower in more deprived areas leading to wide socioeconomic inequalities in live born infants with a congenital anomaly, particularly DS, and subsequent neonatal mortality.

Funding

LKS was funded by the National Institute for Health Research (NIHR) under its Programme Grants for Applied Research (PGfAR) Programme (Grant Reference Number RPPG-0407-10029);Until April 2013, EMSYCAR was funded by the Primary Care Trust in the areas covered by the register. LKS was funded by UK Department of Health's NIHR under its Programme Grants for Applied Research (PGfAR) Programme (Grant Reference Number RP-PG-0407–10029).

History

Citation

Archives of Disease in Childhood: Fetal and Neonatal Edition 2015;100:F400-F404

Author affiliation

/Organisation/COLLEGE OF MEDICINE, BIOLOGICAL SCIENCES AND PSYCHOLOGY/School of Medicine/Department of Health Sciences

Version

VoR (Version of Record)

Published in

Archives of Disease in Childhood: Fetal and Neonatal Edition 2015;100:F400-F404

Publisher

BMJ Publishing Group

issn

1359-2998

eissn

1468-2052

Acceptance date

14/04/2015

Available date

25/08/2015

Publisher version

http://fn.bmj.com/content/100/5/F400

Notes

Aggregated EMSYCAR data may be requested from BINOCAR www.binocar.org.uk.

Language

en

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