Abstract Background Evidence on how poverty and social determinants influence adverse maternal and perinatal outcomes in the UK is limited. While ethnicity and area-level deprivation are well described, fewer studies examine the cumulative impact of poverty-related factors such as low income, employment insecurity, housing, and access to social support. Methods We analysed 67,308 pregnancies from the eLIXIR cohort using linked NHS records. Social determinants were defined using the WHO framework as structural (ethnicity, migration status, area deprivation) and intermediary (housing, employment, financial hardship, social support, barriers to care). The primary outcome was a composite adverse perinatal outcome. Binary logistic regression models with random intercepts accounted for repeated pregnancies, and adjusted risk ratios (aRRs) were estimated controlling for key sociodemographic and clinical factors. Results Structural poverty-related social determinants of health were associated with increased risk of adverse perinatal outcomes, including Black (aRR 1.50, 95% CI 1.42–1.59), Asian (aRR 1.49, 95% CI 1.39–1.59), and other minoritised ethnic backgrounds (aRR 1.50, 95% CI 1.42–1.59), residence in the most deprived areas (aRR 1.10, 95% CI 1.01–1.20), non-UK birth (aRR 1.20, 95% CI 1.15–1.25), and recent migration (aRR 1.32, 95% CI 1.14–1.53). Intermediary poverty-related social determinants of health were independently associated with increased risk beyond ethnicity and deprivation, including lack of social support (aRR 1.21, 95% CI 1.02–1.42), unemployment (aRR 1.16, 95% CI 1.10–1.23), financial hardship (aRR 1.17, 95% CI 1.01–1.35), living in social housing (aRR 1.16, 95% CI 1.09–1.24), transfer of care between hospitals (aRR 1.27, 95% CI 1.18–1.37), missed appointments (aRR 1.19, 95% CI 1.04–1.37), and unscheduled maternity care use (aRR 1.21, 95% CI 1.14–1.29). Women exposed to multiple overlapping poverty-related social determinants of health had a substantially higher likelihood of adverse perinatal outcomes (aRR 1.23, 95% CI 1.12–1.35). Conclusions Structural and intermediary social determinants related to poverty have a substantial and cumulative impact on maternal and perinatal outcomes, independent of individual clinical risk. Addressing these inequities requires integrated, cross-sector strategies that extend beyond healthcare to the wider social conditions influencing maternal and child health. Clinical trial number Not applicable.
Burton et al. (Sat,) studied this question.