Maternal residential area effects on preterm birth, low birth weight and caesarean section in Australia: A systematic review

Habtamu Mellie Bizuayehu; Melissa L Harris; Catherine Chojenta; Girmay Tsegay Kiross; Deborah Loxton

doi:10.1016/j.midw.2023.103704

Maternal residential area effects on preterm birth, low birth weight and caesarean section in Australia: A systematic review

Midwifery. 2023 Aug:123:103704. doi: 10.1016/j.midw.2023.103704. Epub 2023 May 3.

Authors

Habtamu Mellie Bizuayehu¹, Melissa L Harris², Catherine Chojenta², Girmay Tsegay Kiross³, Deborah Loxton²

Affiliations

¹ Centre for Women's Health Research, School of Medicine and Public Health, College of Health, Medicine and Wellbeing, The University of Newcastle, Newcastle, Australia; The First Nations Cancer & Wellbeing Research (FNCWR) Program, School of Public Health, Faculty of Medicine, University of Queensland, Brisbane, QLD, Australia; Department of Public Health, Debre Markos University, Debre Markos, Ethiopia. Electronic address: habtamu.bizuayehu@uon.edu.au.
² Centre for Women's Health Research, School of Medicine and Public Health, College of Health, Medicine and Wellbeing, The University of Newcastle, Newcastle, Australia.
³ Centre for Women's Health Research, School of Medicine and Public Health, College of Health, Medicine and Wellbeing, The University of Newcastle, Newcastle, Australia; Department of Public Health, Debre Markos University, Debre Markos, Ethiopia.

PMID: 37196576
DOI: 10.1016/j.midw.2023.103704

Abstract

Introduction: In Australia, area of residence is an important health policy focus and has been suggested as a key risk factor for preterm birth (PTB), low birth weight (LBW) and cesarian section (CS) due to its influence on socioeconomic status, access to health services, and its relationship with medical conditions. However, there is inconsistent evidence about the relationship of maternal residential areas (rural and urban areas) with PTB, LBW, and CS. Synthesising the evidence on the issue will help to identify the relationships and mechanisms for underlying inequality and potential interventions to reduce such inequalities in pregnancy outcomes (PTB, LBW and CS) in rural and remote areas.

Methods: Electronic databases, including MEDLINE, Embase, CINAHL, and Maternity & Infant Care, were systematically searched for peer-reviewed studies which were conducted in Australia and compared PTB, LBW or CS by maternal area of residence. Articles were appraised for quality using JBI critical appraisal tools.

Results: Ten articles met the eligibility criteria. Women who lived in rural and remote areas had higher rates of PTB and LBW and lower rate of CS compared to their urban and city counterparts. Two articles fulfilled JBI's critical appraisal checklist for observational studies. Compared to women living in urban and city areas, women living in rural and remote areas were also more likely to give birth at a younger age (<20 years) and have chronic diseases such as hypertension and diabetes. They were also less likely to have higher levels of completing university degree education, private health insurance and births in private hospitals.

Conclusions: Addressing the high rate of pre-existing and/or gestational hypertension and diabetes, limited access of health services and a shortage of experienced health staff in remote and rural areas are keys to early identification and intervention of risk factors of PTB, LBW, and CS.

Keywords: Birth outcome; Cesarian section; Low birth weight; Pregnancy outcome; Preterm birth.

Publication types

Systematic Review
Review

MeSH terms

Adult
Birth Weight
Cesarean Section / adverse effects
Female
Humans
Infant, Low Birth Weight
Infant, Newborn
Parturition
Pregnancy
Pregnancy Outcome
Premature Birth* / epidemiology
Premature Birth* / etiology
Young Adult