Obstetrics & Gynaecology - Masters by Research Theses
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Item Socioeconomic deprivation as a risk factor for stillbirth: a case-control study(University College Cork, 2024) Keane, Jessica; Leitao, Sara; Corcoran, Paul; Greene, Richard A.Introduction: Stillbirth (SB) is a devastating outcome for families. Identifying and addressing risk factors is of crucial importance. Level of deprivation has been linked to adverse perinatal outcomes. This thesis aims to comprehensively examine the relationship between area-level deprivation and the risk of SB by conducting a scoping review of international literature and a case-control study using an Irish based cohort. Methods: Guided by the Joanna Briggs Institute methodology and PRISMA-ScR framework, this scoping review focused on studies examining SB in upper-middle and high-income countries using composite geographical indices of deprivation. A systematic search across six scientific databases was performed. The screening process, involving title, abstract, and full text reviews, followed specified inclusion criteria. Data extraction and synthesis were carried out and presented in a narrative summary. An observational case-control study was conducted, matching cases of SB (n=127) with a control cohort of live births (n=266). A ratio of 2 controls to 1 case was identified. Retrospective data over four years (2018-2021) was collected from a tertiary university maternity unit in the Republic of Ireland. The study employed the Pobal HP Deprivation Index to categorise small areas into levels of deprivation, ranging from affluence to deprivation. Variables, including maternal age, parity, BMI, booking visit gestation were identified as confounding factors. Statistical analysis was conducted using SPSS and included; frequency tables to present the distribution of certain variables, Chi-squared tests to identify associations between deprivation and the confounding factors with risk of SB, T-tests and logistic regression for crude and multivariate analysis on the relevant confounding factors, including odds ratio calculations, to identify any significant differences in the risk of SB across the deprivation levels and categories of the confounding factors. Results: A total of 29 studies were included in the scoping review, from 9 countries (the majority UK-based; n=20, followed by the Netherlands; n=2 and Brazil; n=2). A range of deprivation indices were utilised internationally (n=18), the UK’s Index of Multiple Deprivation (IMD) was the most commonly used (n=8), followed by the Townsend and Jarman indices (n=6 and n=3, respectively). Income, employment, education and access to services were some of the most common factors included in the indices. Results show an association between SB rates and areas identified as being more deprived, with 22 of the 29 studies (75.9%) showing positive correlations. The results of the case-control study demonstrated no statistically significant correlation between level of deprivation and risk of experiencing SB within our sample (p-value 0.288). When readjusted into quintiles of deprivation, a slightly higher representation of SB was noted in the more deprived levels, though not significant. When examined by cause of death, there was a significant association between deprivation and placental causes of death (p-value 0.045). BMI was consistently associated with risk of SB, while booking visit gestation and maternal age also showed associations. Conclusion: This comprehensive investigation into the relationship between area-level deprivation and SB risk provides important insights. The complex nature of measuring deprivation and of SB aetiology is demonstrated. The scoping review suggests that countries and regions should consider assessing deprivation when evaluating their SB rates, as this could offer valuable information for care programme development to impact deprived areas. While the case control study demonstrates the need for further national research to understand the relationship between deprivation and adverse perinatal outcome in the Irish context. Ultimately, using the evidence to guide and inform local policy and resource management will aid in tackling the inequalities in healthcare provision, thus encouraging equal and quality maternity care. Tailored initiatives have the potential to enhance healthcare services, clinical practice, and ultimately improve maternal and perinatal outcomes.