The Association of Maternal and Socioeconomic Characteristics in Metropolitan Adelaide with Medical, Obstetric and Labour Complications and Pregnancy Outcomes

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Abstract
EDITORIAL COMMENT:The use of residential area as a marker of socioeconomic status in Australia has been taken up by social scientists and public health researchers. There is inevitably some misclassification which is more likely for couples with young children. Another comment provided by our reviewer is that validation studies have shown that there is marked underreporting of antenatal complications in private patients. This is obviously true since the clinic patient has her complete antenatal record available for coding and classification, whereas the private patient's history includes only what the doctor remembers when he completes the record; how many readers ensure that all abnormalities recorded on their private patient's antenatal card are transferred to the hospital history after delivery? Another consideration is that disorders detected only by screening (gestational diabetes) will only be found if the test is performed and the result recorded in the patient's history. Differences between public and private hospitals or between public and private patients may therefore account for or contribute to some of the outcome differences in tables 1 and 2.SummaryMultiple regression analysis was used to measure associations of maternal age, race, gravidity, marital status and socioeconomic status with medical problems and pregnancy outcomes. The study population comprised all singleton births to residents of metropolitan Adelaide (in South Australia) during 1988 that were included in the State's perinatal statistics collection. The results indicate that in metropolitan Adelaide, low socioeconomic status is related to a higher risk profile of mothers and babies. It also highlights that there is a strong association of divorce and separation with medical problems and an adverse pregnancy outcome. Poorer outcomes are also seen in never married women, teenage women, older women, non‐Caucasian women and primigravid women. These poorer outcomes in older women and primigravidas include higher risks of low birth‐weight and prematurity of their babies. The study also demonstrates that groups that are less likely to have choice of obstetric care, eg. teenage women, non‐Caucasian women, and women of low socioeconomic status, have a lower odds of obstetric intervention as characterized by nonspontaneous labour and elective Caesarean section.

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