Ethnicity and social inequalities in maternity outcomes: a single centre observational study

Background This study investigates the impact of deprivation and ethnicity on birth outcomes in a large area of Northwest England. It is a single-centre retrospective observational study of births from 22 weeks of gestation between January 2018 and December 2022 at the Northern Care Alliance NHS Foundation Trust (NCA), Greater Manchester, which has a level three maternity unit. Methods Data for 24,045 pregnancies over a 5-year period were extracted from electronic databases. Index of Multiple Deprivation (IMD) quintiles were generated from patients’ residential postcodes, with lower IMD status indicating greater socioeconomic deprivation. Univariate and multivariate logistic regression identified predictors of poor outcomes with a focus on maternal deprivation and ethnic background. The primary outcome was an adverse birth outcome, which included stillbirth (after 24 weeks), early neonatal death (after any gestation), extreme prematurity (22–27 weeks gestation) and very premature (28–31 weeks) in singleton pregnancies. Results 42.6% of pregnancies involved ethnic minority groups (EMG), and 61% of all mothers were living in the most socially deprived index of multiple deprivation (IMD) quintile. Poor outcomes, including stillbirth (0.7 vs. 0.4%, p = 0.03) and early neonatal death (0.3 vs. 0.2%, p = 0.018), were significantly higher in EMG than White women. Premature deliveries were more frequent in pregnancies from mothers living in areas of highest deprivation ( p < 0.001). In multivariate logistic regression analysis, EMG (OR: 1.25, p = 0.042), higher maternal age (OR: 1.03, p = 0.006), hypertension history (OR: 2.18, p < 0.001) and a lower IMD status (OR: 1.81, p = 0.002) were all shown to be independent predictors of an adverse birth outcome. Conclusions The study reinforces the link between ethnicity, deprivation and pregnancy outcomes, with women from both lower IMD and EMG backgrounds being at risk of poorer outcomes.