{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,12,16]],"date-time":"2025-12-16T14:00:43Z","timestamp":1765893643136,"version":"3.48.0"},"reference-count":43,"publisher":"BMJ","issue":"11","license":[{"start":{"date-parts":[[2021,11,17]],"date-time":"2021-11-17T00:00:00Z","timestamp":1637107200000},"content-version":"unspecified","delay-in-days":16,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"DOI":"10.13039\/100014609","name":"Public Health Wales","doi-asserted-by":"publisher","award":["N\/A"],"award-info":[{"award-number":["N\/A"]}],"id":[{"id":"10.13039\/100014609","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2021,10,25]]},"published-print":{"date-parts":[[2021,11]]},"abstract":"<jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>The aim of this study was to assess the relationship between deciles of area-level deprivation and seven adverse pregnancy outcomes in Wales.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design<\/jats:title>\n                    <jats:p>Cross-sectional analysis.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Setting<\/jats:title>\n                    <jats:p>64\u2009699 live births in Wales from 31 March 2014 to 16 September 2019.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Primary outcome variable<\/jats:title>\n                    <jats:p>We examined each of the following seven adverse pregnancy outcomes: (1) small for gestational age (SGA); (2) large for gestational age; (3) preterm birth; (4) third-degree or fourth-degree perineal tear; (5) major postpartum haemorrhage (MPPH); (6) a lower Apgar score at 5\u2009min and (7) emergency caesarean section.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>There was no significant association between increasing aggregate measures of area-level deprivation and the adverse pregnancy outcomes we studied. Women living in an area with greater access to services are more likely to have a baby that is SGA (1.27, 95%\u2009CI 1.11 to 1.49), have a greater likelihood of a perineal tear (1.74, 95%\u2009CI 1.15 to 2.61), are significantly less likely to have MPPH (0.79, 95%\u2009CI 0.64 to 0.96), have a baby with an Apgar score of 0.26 higher (95%\u2009CI 0.22 to 0.29) and are significantly less likely to have an emergency caesarean section (0.81, 95%\u2009CI 0.73 to 0.88). Women living in areas with higher employment (0.26, 95%\u2009CI 0.19 to 0.36) and better health (0.26, 95%\u2009CI 0.19 to 0.35) were less likely to experience perineal tear.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>There was no clear social-spatial gradient in area-level deprivation and adverse pregnancy outcomes. We found a stronger association for individual-level behavioural risk factors than area-level factors. These findings support the benefits that accessible and holistic person-centred care may bring through addressing individual behavioural risk factors. There is a need for improved data completeness and further individual-level data on risk factors such as employment and income to better understand the role which may be played by population-level policies and their pathways to affecting outcomes.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjopen-2021-052330","type":"journal-article","created":{"date-parts":[[2021,11,17]],"date-time":"2021-11-17T11:49:19Z","timestamp":1637149759000},"page":"e052330","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":1,"title":["Assessing the relationship between adverse pregnancy outcomes and area-level deprivation in Wales 2014\u20132019: a national population-based cross-sectional study"],"prefix":"10.1136","volume":"11","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0067-991X","authenticated-orcid":false,"given":"Heather","family":"Brown","sequence":"first","affiliation":[{"name":"Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Amrita","family":"Jesurasa","sequence":"additional","affiliation":[{"name":"Public Health Wales, Cardiff, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Clare","family":"Bambra","sequence":"additional","affiliation":[{"name":"Health & Society, Newcastle University, Newcastle upon Tyne, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Judith","family":"Rankin","sequence":"additional","affiliation":[{"name":"Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Amy","family":"McNaughton","sequence":"additional","affiliation":[{"name":"Public Health Wales, Cardiff, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nicola","family":"Heslehurst","sequence":"additional","affiliation":[{"name":"Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2021,11,17]]},"reference":[{"key":"2025121605583689000_11.11.e052330.1","first-page":"672","article-title":"The association between birthweight 4000 G or greater and perinatal outcomes in patients with and without gestational diabetes mellitus","volume":"20019376489","author":"Esakoff","year":"2009","journal-title":"Am J Obstet Gynecol"},{"key":"2025121605583689000_11.11.e052330.2","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0047776"},{"key":"2025121605583689000_11.11.e052330.3","doi-asserted-by":"publisher","DOI":"10.1210\/jc.2008-0488"},{"key":"2025121605583689000_11.11.e052330.4","doi-asserted-by":"publisher","DOI":"10.1093\/ije\/dym067"},{"key":"2025121605583689000_11.11.e052330.5","doi-asserted-by":"publisher","DOI":"10.1111\/j.1600-0412.2012.01412.x"},{"key":"2025121605583689000_11.11.e052330.6","doi-asserted-by":"publisher","DOI":"10.1016\/S1047-2797(01)00249-6"},{"key":"2025121605583689000_11.11.e052330.7","doi-asserted-by":"publisher","DOI":"10.1136\/tobaccocontrol-2016-053476"},{"key":"2025121605583689000_11.11.e052330.8","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pmed.1001990"},{"key":"2025121605583689000_11.11.e052330.9","doi-asserted-by":"publisher","DOI":"10.1111\/j.1365-3016.2006.00719.x"},{"key":"2025121605583689000_11.11.e052330.10","doi-asserted-by":"publisher","DOI":"10.1111\/j.1365-3016.2011.01192.x"},{"key":"2025121605583689000_11.11.e052330.11","doi-asserted-by":"crossref","DOI":"10.1186\/s13561-019-0226-x","article-title":"Neighborhood characteristics as determinants of healthcare utilization - a theoretical model","volume":"9","author":"Mohnen","year":"2019","journal-title":"Health Econ Rev"},{"key":"2025121605583689000_11.11.e052330.12","doi-asserted-by":"publisher","DOI":"10.1111\/j.1749-6632.2009.05333.x"},{"key":"2025121605583689000_11.11.e052330.13","doi-asserted-by":"publisher","DOI":"10.1111\/j.1753-4887.2007.00001.x"},{"key":"2025121605583689000_11.11.e052330.14","doi-asserted-by":"publisher","DOI":"10.1136\/archdischild-2018-316124"},{"key":"2025121605583689000_11.11.e052330.15","doi-asserted-by":"crossref","first-page":"541","DOI":"10.1093\/pubmed\/fdaa025","article-title":"Are infant mortality rates increasing in England? 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