{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,7,30]],"date-time":"2025-07-30T16:31:05Z","timestamp":1753893065745,"version":"3.41.2"},"reference-count":67,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2025,4,15]],"date-time":"2025-04-15T00:00:00Z","timestamp":1744675200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Public Health"],"abstract":"<jats:sec><jats:title>Introduction<\/jats:title><jats:p>Birmingham and Solihull face significant challenges related to adverse birth outcomes. This study aimed to identify demographic, socioeconomic, and lifestyle factors associated with an increased risk of low birth weight, premature birth, stillbirth, and neonatal death in Birmingham and Solihull.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Births (<jats:italic>n<\/jats:italic> = 41, 231) between October 2020 and April 2023 were analysed. The attributable fraction of premature births and low birth weight (LBW) attributable to socioeconomic and ethnic inequality was calculated. Multiple logistic regression analyses identified groups that had increased odds of premature birth (<jats:italic>n<\/jats:italic> = 3, 312), LBW (<jats:italic>n<\/jats:italic> = 1, 197), stillbirth (<jats:italic>n<\/jats:italic> = 173), and neonatal death (<jats:italic>n<\/jats:italic> = 208).<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Attributable fraction analysis estimated that 191 premature births and 211 LBWs each year would not have occurred if all women had the same rates as White women living in the least deprived areas. Ethnicity, socioeconomic deprivation, medical care, lifestyle, and vulnerability status were found to be significant risk factors for adverse birth outcomes. Asian and Black women had 1.4\u20132.7 times the odds of LBW compared to White women (<jats:italic>p<\/jats:italic> &amp;lt; 0.01). Black women had increased odds of stillbirth (OR : 1.75, <jats:italic>p<\/jats:italic> = 0.017) and Asian women had increased odds of neonatal death (OR : 1.90, <jats:italic>p<\/jats:italic> &amp;lt; 0.001). The odds of LBW (OR : 3.3), premature birth (OR : 27.2), and neonatal death (OR : 5.6) were significantly increased for twins (<jats:italic>p<\/jats:italic> &amp;lt; 0.001). For women smoking at delivery, the odds of LBW (OR : 2.3), premature birth (OR : 1.5), and stillbirth (OR : 1.6) were significantly increased (<jats:italic>p<\/jats:italic> &amp;lt; 0.05). Deprivation, and\/or financial and housing issues also increased the odds of adverse birth outcomes (<jats:italic>p<\/jats:italic> &amp;lt; 0.05).<\/jats:p><\/jats:sec><jats:sec><jats:title>Discussion<\/jats:title><jats:p>These findings underscore the importance of targeted interventions and support for at-risk populations to reduce adverse birth outcomes in vulnerable communities.<\/jats:p><\/jats:sec>","DOI":"10.3389\/fpubh.2025.1544903","type":"journal-article","created":{"date-parts":[[2025,4,15]],"date-time":"2025-04-15T05:20:21Z","timestamp":1744694421000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":1,"title":["Wider determinants of adverse birth outcomes in Birmingham and Solihull"],"prefix":"10.3389","volume":"13","author":[{"given":"David","family":"Ellis","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Chung Him","family":"Au-Yeung","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Alexander","family":"Dallaway","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ranjana","family":"Basra","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sylvia","family":"Owusu-Nepaul","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jenny","family":"Riley","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Rebecca","family":"Howell-Jones","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Justin","family":"Varney","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Marion","family":"Gibbon","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1965","published-online":{"date-parts":[[2025,4,15]]},"reference":[{"key":"B1","unstructured":"Office for health improvement and disparities\n          \n          \n          Public Health Profiles 2024\n          \n          2024"},{"key":"B2","unstructured":"Deprivation in Birmingham analysis of the 2019, in Indices of Deprivation\n          \n          2019"},{"key":"B3","unstructured":"Deprivation in Solihull\n          \n          2019"},{"key":"B4","doi-asserted-by":"publisher","first-page":"964","DOI":"10.1136\/bmjopen-2012-000964","article-title":"Social inequality and infant health in the UK: systematic review and meta-analyses","volume":"2","author":"Weightman","year":"2012","journal-title":"BMJ Open"},{"key":"B5","doi-asserted-by":"publisher","first-page":"e042753","DOI":"10.1136\/bmjopen-2020-042753","article-title":"Socioeconomic inequalities and adverse pregnancy outcomes in the UK and Republic of Ireland: a systematic review and meta-analysis","volume":"11","author":"Thomson","year":"2021","journal-title":"BMJ Open"},{"key":"B6","doi-asserted-by":"publisher","first-page":"e028227","DOI":"10.1136\/bmjopen-2018-028227","article-title":"Joint contribution of socioeconomic circumstances and ethnic group to variations in preterm birth, neonatal mortality and infant mortality in England and Wales: a population-based retrospective cohort study using routine data from 2006 to 2012","volume":"9","author":"Opondo","year":"2019","journal-title":"BMJ Open"},{"key":"B7","doi-asserted-by":"publisher","first-page":"e029424","DOI":"10.1136\/bmjopen-2019-029424","article-title":"Assessing the impact of rising child poverty on the unprecedented rise in infant mortality in England, 2000\u20132017: time trend analysis","volume":"9","author":"Taylor-Robinson","year":"2019","journal-title":"BMJ Open"},{"key":"B8","unstructured":"Census 2021\n          \n          2021"},{"key":"B9","doi-asserted-by":"publisher","first-page":"240","DOI":"10.1053\/j.semperi.2011.02.021","article-title":"Social and ethnic inequalities in infant mortality: a perspective from the United Kingdom","volume":"35","author":"Hollowell","year":"2011","journal-title":"Semin Perinatol"},{"key":"B10","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1371\/journal.pone.0195146","article-title":"The contribution of gestational age, area deprivation and mother's country of birth to ethnic variations in infant mortality in England and Wales: A national cohort study using routinely collected data","volume":"13","author":"Li","year":"2018","journal-title":"PLoS ONE"},{"key":"B11","doi-asserted-by":"publisher","first-page":"e1477418","DOI":"10.3389\/fpubh.2024.1477418","article-title":"Socioeconomic and ethnic inequalities increase the risk of type 2 diabetes: an analysis of NHS health check attendees in Birmingham","volume":"12","author":"Au-Yeung","year":"2024","journal-title":"Front Public Health"},{"key":"B12","doi-asserted-by":"publisher","first-page":"1905","DOI":"10.1016\/S0140-6736(21)01595-6","article-title":"Adverse pregnancy outcomes attributable to socioeconomic and ethnic inequalities in England: a national cohort study","volume":"398","author":"Jardine","year":"2021","journal-title":"Lancet"},{"key":"B13","doi-asserted-by":"publisher","first-page":"101433","DOI":"10.1016\/j.eclinm.2022.101433","article-title":"On race and ethnicity during a global pandemic: An imperfect mosaic of maternal and child health services in ethnically-diverse South London, United Kingdom","volume":"48","author":"Silverio","year":"2022","journal-title":"eClinicalMedicine"},{"key":"B14","first-page":"33","article-title":"Maternal and infant health of Eastern Europeans in Bradford, UK: a qualitative study","volume":"87","author":"Richards","year":"2014","journal-title":"Commun Practit"},{"key":"B15","unstructured":"English Indices of Deprivation 2019\n          \n          2019"},{"key":"B16","unstructured":"What is BadgerNet\n          \n          2023"},{"key":"B17","unstructured":"Births and Deaths Registration Act 1953\n          \n          1953"},{"key":"B18","doi-asserted-by":"publisher","first-page":"e20160551","DOI":"10.1542\/peds.2016-0551","article-title":"Standard terminology for fetal, infant, and perinatal deaths","volume":"137","author":"Barfield","year":"2016","journal-title":"Pediatrics"},{"key":"B19","unstructured":"New Guidelines on Antenatal Care for a Positive Pregnancy Experience\n          \n          2016"},{"key":"B20","unstructured":"forestplot: advanced forest plot using \u2018grid' graphics\n          \n          \n            \n              Gordon\n              M\n            \n            \n              Lumley\n              T\n            \n          \n          R Package Version 3.1.3\n          \n          2023"},{"key":"B21","doi-asserted-by":"publisher","first-page":"2049","DOI":"10.2139\/ssrn.4023225","article-title":"Effects of race and ethnicity on perinatal outcomes in high-income and upper-middle-income countries: an individual participant data meta-analysis of 2 198 655 pregnancies","volume":"400","author":"Sheikh","year":"2022","journal-title":"Lancet"},{"key":"B22","doi-asserted-by":"publisher","first-page":"2175","DOI":"10.1111\/jan.15233","article-title":"Black, Asian and minority ethnic women's experiences of maternity services in the UK: A qualitative evidence synthesis","volume":"78","author":"MacLellan","year":"2022","journal-title":"J Adv Nurs"},{"key":"B23","article-title":"Recorded delivery 2006","author":"Redshaw","year":"2023","journal-title":"National Maternity-Survey-Report Oxford: National Perinatal Epidemiology Unit"},{"key":"B24","doi-asserted-by":"publisher","first-page":"S619","DOI":"10.1016\/j.ajog.2017.12.010","article-title":"The World Health Organization fetal growth charts: concept, findings, interpretation, and application","volume":"218","author":"Kiserud","year":"2018","journal-title":"Am J Obstet Gynecol"},{"key":"B25","doi-asserted-by":"publisher","first-page":"449","DOI":"10.1016\/j.ajog.2015.08.032","article-title":"Racial\/ethnic standards for fetal growth: the NICHD Fetal Growth Studies","volume":"213","author":"Louis","year":"2015","journal-title":"Am J Obstet Gynecol"},{"key":"B26","doi-asserted-by":"publisher","first-page":"1360","DOI":"10.1093\/aje\/kwaa054","article-title":"To what extent is the association between race\/ethnicity and fetal growth restriction explained by adequacy of prenatal care? A mediation analysis of a retrospectively selected cohort","volume":"189","author":"Nasiri","year":"2020","journal-title":"Am J Epidemiol"},{"key":"B27","doi-asserted-by":"publisher","first-page":"S4","DOI":"10.1016\/j.puhe.2012.05.014","article-title":"Fair society, healthy lives","volume":"126","author":"Marmot","year":"2012","journal-title":"Public Health"},{"key":"B28","doi-asserted-by":"publisher","first-page":"1487","DOI":"10.1017\/S0007114509990444","article-title":"Diet and deprivation in pregnancy","volume":"102","author":"Haggarty","year":"2009","journal-title":"Br J Nutr"},{"key":"B29","doi-asserted-by":"publisher","first-page":"CD007145","DOI":"10.1002\/14651858.CD007145.pub3","article-title":"Diet or exercise, or both, for preventing excessive weight gain in pregnancy","volume":"2015","author":"Muktabhant","year":"2015","journal-title":"Coch Datab Systematic Reviews"},{"key":"B30","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1093\/heapol\/11.1.1","article-title":"Is antenatal care effective in reducing maternal morbidity and mortality?","volume":"11","author":"McDonagh","year":"1996","journal-title":"Health Policy Plan"},{"key":"B31","doi-asserted-by":"publisher","first-page":"487","DOI":"10.1067\/mob.2002.121073","article-title":"The maternal lifestyle study: drug exposure during pregnancy and short-term maternal outcomes","volume":"186","author":"Bauer","year":"2002","journal-title":"Am J Obstet Gynecol"},{"key":"B32","doi-asserted-by":"publisher","first-page":"24","DOI":"10.1016\/j.neubiorev.2005.04.005","article-title":"Maternal smoking, drinking or cannabis use during pregnancy and neurobehavioral and cognitive functioning in human offspring","volume":"30","author":"Huizink","year":"2006","journal-title":"Neurosci Biobehav Rev"},{"key":"B33","doi-asserted-by":"publisher","first-page":"1341","DOI":"10.1067\/mob.2003.274","article-title":"Intimate partner violence and adverse pregnancy outcomes: a population-based study","volume":"188","author":"Janssen","year":"2003","journal-title":"Am J Obstet Gynecol"},{"volume-title":"Psychosocial Pathways and Health Outcomes: INFORMING Action on Health Inequalities","year":"2017","author":"Bell","key":"B34"},{"key":"B35","doi-asserted-by":"publisher","first-page":"120","DOI":"10.1016\/j.healthplace.2014.02.001","article-title":"Neighborhood socioeconomic deprivation, perceived neighborhood factors, and cortisol responses to induced stress among healthy adults","volume":"27","author":"Barrington","year":"2014","journal-title":"Health Place"},{"key":"B36","doi-asserted-by":"publisher","first-page":"3553","DOI":"10.1210\/jc.2007-0445","article-title":"Effects of Cortisol on carbohydrate, lipid, and protein metabolism: studies of acute cortisol withdrawal in adrenocortical failure","volume":"92","author":"Christiansen","year":"2007","journal-title":"J Clini Endocrinol Metabol"},{"key":"B37","doi-asserted-by":"publisher","first-page":"233","DOI":"10.1038\/nri.2017.1","article-title":"Immune regulation by glucocorticoids","volume":"17","author":"Cain","year":"2017","journal-title":"Nat Rev Immunol"},{"key":"B38","doi-asserted-by":"publisher","first-page":"1085950","DOI":"10.3389\/fendo.2023.1085950","article-title":"Understanding the relationships between physiological and psychosocial stress, cortisol and cognition","volume":"14","author":"James","year":"2023","journal-title":"Front Endocrinol"},{"key":"B39","doi-asserted-by":"publisher","first-page":"807","DOI":"10.1093\/aje\/kwt334","article-title":"Systematic review and meta-analysis of miscarriage and maternal exposure to tobacco smoke during pregnancy","volume":"179","author":"Pineles","year":"2014","journal-title":"Am J Epidemiol"},{"key":"B40","doi-asserted-by":"publisher","first-page":"239","DOI":"10.1186\/s12889-015-1552-5","article-title":"Maternal smoking and the risk of still birth: systematic review and meta-analysis","volume":"15","author":"Marufu","year":"2015","journal-title":"BMC Public Health"},{"key":"B41","doi-asserted-by":"publisher","first-page":"87","DOI":"10.1093\/aje\/kwv301","article-title":"Systematic review and meta-analyses of perinatal death and maternal exposure to tobacco smoke during pregnancy","volume":"184","author":"Pineles","year":"2016","journal-title":"Am J Epidemiol"},{"key":"B42","doi-asserted-by":"publisher","first-page":"1092","DOI":"10.1016\/0002-9378(71)90109-8","article-title":"Comas-urrutia AC, Mueller-Heubach E, Morishima HO, Adamsons K. Pharmacologic effects of nicotine upon the fetus and mother in the rhesus monkey","volume":"111","author":"Suzuki","year":"1971","journal-title":"Am J Obstet Gynecol"},{"key":"B43","first-page":"115","article-title":"The maternal and fetal physiologic effects of nicotine","volume-title":"Seminars in Perinatology","author":"Lambers","year":"1996"},{"key":"B44","doi-asserted-by":"publisher","first-page":"109","DOI":"10.1016\/j.ajog.2016.01.167","article-title":"Relationship of trimester-specific smoking patterns and risk of preterm birth","volume":"215","author":"Moore","year":"2016","journal-title":"Am J Obstet Gynecol"},{"key":"B45","doi-asserted-by":"publisher","first-page":"e192514","DOI":"10.1001\/jamanetworkopen.2019.2514","article-title":"Association of maternal cigarette smoking and smoking cessation with preterm birth","volume":"2","author":"Soneji","year":"2019","journal-title":"JAMA Netw Open"},{"volume-title":"Hiding in Plain Sight: Treating Tobacco Dependency in the NHS","year":"2018","key":"B46"},{"key":"B47","doi-asserted-by":"publisher","first-page":"00130","DOI":"10.1183\/23120541.00130-2016","article-title":"Is individual smoking behaviour influenced by area-level ethnic density? A cross-sectional electronic health database study of inner south-east London","volume":"3","author":"Mathur","year":"2017","journal-title":"ERJ Open Res"},{"key":"B48","unstructured":"Deprivation and the Impact on Smoking Prevalence, England and Wales: 2017 to 2021\n          \n          2021"},{"key":"B49","doi-asserted-by":"publisher","first-page":"113","DOI":"10.1016\/S0020-7292(99)00181-2","article-title":"M\u00f8ller M, Olsen J, S\u00f8rensen HT. A population-based cohort study of birth and neonatal outcome in older primipara","volume":"68","author":"Yuan","year":"2000","journal-title":"Int J Gynecol Obstet"},{"key":"B50","doi-asserted-by":"publisher","first-page":"910","DOI":"10.1016\/S0306-5456(01)00214-5","article-title":"Can obstetric complications explain the high levels of obstetric interventions and maternity service use among older women? A retrospective analysis of routinely collected data","volume":"108","author":"Bell","year":"2001","journal-title":"Br J Obstetr Gynaecol"},{"key":"B51","unstructured":"Joint Strategic Needs Assessment (JSNA)\n          \n          2024"},{"key":"B52","doi-asserted-by":"publisher","first-page":"793","DOI":"10.1016\/j.midw.2010.07.006","article-title":"Advanced maternal age and adverse perinatal outcome: a review of the evidence","volume":"27","author":"Carolan","year":"2011","journal-title":"Midwifery"},{"key":"B53","doi-asserted-by":"publisher","first-page":"c3428","DOI":"10.1136\/bmj.c3428","article-title":"Overweight and obesity in mothers and risk of preterm birth and low birth weight infants: systematic review and meta-analyses","volume":"341","author":"McDonald","year":"2010","journal-title":"BMJ"},{"key":"B54","doi-asserted-by":"publisher","first-page":"2070","DOI":"10.2337\/dc06-2559a","article-title":"Maternal obesity and risk of gestational diabetes mellitus","volume":"30","author":"Chu","year":"2007","journal-title":"Diabet Care"},{"key":"B55","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1186\/1471-2393-12-23","article-title":"Gestational diabetes and pregnancy outcomes-a systematic review of the World Health Organization (WHO) and the International Association of Diabetes in Pregnancy Study Groups (IADPSG) diagnostic criteria","volume":"12","author":"Wendland","year":"2012","journal-title":"BMC Pregn Childbirth"},{"key":"B56","doi-asserted-by":"publisher","first-page":"221.e1","DOI":"10.1016\/j.ajog.2016.04.044","article-title":"Dichorionic twin trajectories: the NICHD Fetal Growth Studies","volume":"215","author":"Grantz","year":"2016","journal-title":"Am J Obstet Gynecol"},{"key":"B57","doi-asserted-by":"publisher","first-page":"247","DOI":"10.1002\/uog.15821","article-title":"ISUOG Practice Guidelines: role of ultrasound in twin pregnancy","volume":"47","author":"Khalil","year":"2016","journal-title":"Ultrasound Obstet Gynecol"},{"key":"B58","first-page":"3","article-title":"Effect of consanguinity on low birth weight: a meta-analysis","volume":"20","author":"Poorolajal","year":"2017","journal-title":"Arch Iran Med."},{"key":"B59","doi-asserted-by":"publisher","first-page":"87","DOI":"10.1016\/j.ejogrb.2018.10.042","article-title":"A review of the reproductive consequences of consanguinity","volume":"232","author":"Oniya","year":"2019","journal-title":"Eur J Obstet Gynecol Reprod Biol"},{"key":"B60","unstructured":"Committing to implementation of the Global Strategy for Womens, Children's and Adolescents Health (2016\u20132030)\n          \n          2023"},{"key":"B61","unstructured":"Levels and Trends in Child Mortality\n          \n          2023"},{"key":"B62","unstructured":"National Maternity Review\n          \n          2016"},{"key":"B63","unstructured":"NHS England Long-Term Plan A Summary of Child Health Proposals\n          \n          2019"},{"key":"B64","unstructured":"Implementing the Recommendations of the Neonatal Critical Care Transformation Review\n          \n          2019"},{"volume-title":"Ethnicity Coding in English Health Service Datasets","year":"2021","author":"Scobie","key":"B65"},{"key":"B66","unstructured":"Birmingham and Lewisham African and Caribbean Health Inequalities Review (BLACHIR)\n          \n          2022"},{"key":"B67","doi-asserted-by":"publisher","first-page":"7","DOI":"10.3109\/03014460.2011.544139","article-title":"Revised birth centiles for weight, length and head circumference in the UK-WHO growth charts","volume":"38","author":"Cole","year":"2011","journal-title":"Ann Hum Biol"}],"container-title":["Frontiers in Public Health"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fpubh.2025.1544903\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,4,15]],"date-time":"2025-04-15T05:20:35Z","timestamp":1744694435000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fpubh.2025.1544903\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,4,15]]},"references-count":67,"alternative-id":["10.3389\/fpubh.2025.1544903"],"URL":"https:\/\/doi.org\/10.3389\/fpubh.2025.1544903","relation":{},"ISSN":["2296-2565"],"issn-type":[{"type":"electronic","value":"2296-2565"}],"subject":[],"published":{"date-parts":[[2025,4,15]]},"article-number":"1544903"}}