Effects of Social Determinants of Health and Health Services on Pregnancy Outcome (A Cohort Study)

Abstract

Healthy Mothers & Babies are valued hopes and dreams of families of all cultural heritages and national health goals in several countries round the world prioritize infant health. It has long been understood that health outcomes are profoundly shaped not just by biological factors but also by the social، economic and cultural environment، including people’s positions in various social hierarchies. Increasing evidence suggests that it is possible to improve pregnancy outcomes through action on these social determinants of health and maternal health care. This document contributes to the ongoing debate by considering maternal health and asking what can be done to improve maternal health outcomes through action on social determinants and prenatal and preconception care. Method: A cohort of 600 pregnant women was recruited from 20 public and one private antenatal health care services in Tabriz city .after stratification by geographical region centers randomly was selected and they were followed up from the time of pregnancy diagnose till 4 months after delivery.(August2012 to September 2013). Socioeconomic indicators and pregnancy care based upon health ministry guidelines; and Pregnancy outcomes were measured and assessed. Chi square test، regression analysis (univariate and multivariate) was done by SPSS version 17 . Result: we found significant relationship between preconception care and pregnancy complication.(0R:2/6).the incidence of complication at all was 19/2% PTL:4/6%,LBW:9/2%,Preeclampsia:4/2, Gestational diabet:3/9% macrosomia:2/8 ،Cesarean section:74%. Complications were seen in rural area: 83/3 %( most common:PTL), private office:10/4% (Most common: bleeding and diabetes) and urban centers :6/2%. (Most common: abortion) Maternal education showed a significant relation with cesarean section and abortion. BMI plays a major role in almost all poor pregnancy outcomes (LBW، PTB، Cesarean section، miscarriage) and income status was the first predictor of low birth weight. Socio demographic and behavioral factors were particularly important for predicting miscarriage، preterm labor and low birth weight.