PP.21 The Effect of Factors of Social Exclusion on Access to Antenatal Care and the Subsequent Impact on Fetal Outcomes

Abstract

OBJECTIVE: Delayed and erratic access to antenatal care are linked to direct and indirect maternal deaths and morbidity. Social deprivation also accounts for much maternal and child ill-health, with much national and regional health data showing discrepancies in the access and utilisation of care by groups of women who differ by ethnicity, age and socioeconomic status. We sought to map the prevalence of social deprivation and delayed access to antenatal care amongst women attending a regional referral maternity service in South Yorkshire, England, and to correlate them to key adverse maternal and fetal outcomes. STUDY DESIGN: We retrospectively analysed pregnancy data collected from 59,487 consecutive singleton births at the Jessop Wing Hospital, Sheffield, UK, between 2002 and 2010, identifying maternal demographic features and neonatal outcomes. Using regional ordinance maps, we also plotted the Index of Multiple Deprivation (IMD) scores of the women against the distribution of delayed access to antenatal care. RESULTS: There was a close match between the geographic distribution of high deprivation scores and first pregnancy care attendance after 20 weeks gestation. High IMD scores increased the risk of being a late booker (OR: 1.092, 95% CI: 1.01-1.18, p = 0.031) and of being of minority ethnic extraction (OR: 5.6, 95% CI: 5.2-5.9, p<0.001), and significantly predicted low birthweight (OR: 1.66, 95% CI: 1.31-2.12, p<0.001), premature delivery (OR: 1.34, 95% CI: 1.06-1.70, p=0.017) and still birth (OR: 2.25, (95% CI: 1.68-3.01, p<0.001). When sociodemographic variables were adjusted for, late booking per se did not independently predict adverse maternal or fetal outcomes. CONCLUSION: The use of geographic mapping of high social deprivation scores can help identify communities that may benefit from research and health care delivery strategies that seek to promote better access to pregnancy care, minimise late antenatal attendance, and mitigate the resulting adverse maternal and fetal outcomes. (Graph Presented).