Article Text

Original research
Socioeconomic inequalities and adverse pregnancy outcomes in the UK and Republic of Ireland: a systematic review and meta-analysis
  1. Katie Thomson1,
  2. Malcolm Moffat1,
  3. Oluwatomi Arisa1,
  4. Amrita Jesurasa2,
  5. Catherine Richmond1,
  6. Adefisayo Odeniyi1,
  7. Clare Bambra1,3,
  8. Judith Rankin1,3,
  9. Heather Brown1,3,
  10. Julie Bishop4,
  11. Susan Wing4,
  12. Amy McNaughton4,
  13. Nicola Heslehurst1,3
  1. 1Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
  2. 2Primary Care Division, Public Health Wales, Cardiff, UK
  3. 3Fuse, The Centre for Translational Research in Public Health, Newcastle University, Newcastle upon Tyne, Tyne and Wear, UK
  4. 4Health Improvement Division, Public Health Wales, Cardiff, UK
  1. Correspondence to Nicola Heslehurst; nicola.heslehurst{at}


Objective There has been an unprecedented rise in infant mortality associated with deprivation in recent years in the United Kingdom (UK) and Republic of Ireland. A healthy pregnancy can have significant impacts on the life chances of children. The objective of this review was to understand the association between individual-level and household-level measures of socioeconomic status and adverse pregnancy outcomes.

Design Systematic review and meta-analysis.

Data sources Nine databases were searched (Medline, Embase, Scopus, ASSIA, CINAHL, PsycINFO, BNI, MIDRIS and Google Scholar) for articles published between 1999 and August 2019. Grey literature searches were also assessed.

Study selection criteria Studies reporting associations between individual-level or household socioeconomic factors on pregnancy outcomes in the UK or Ireland.

Results Among the 82 353 search results, 53 821 titles were identified and 35 unique studies met the eligibility criteria. Outcomes reported were neonatal, perinatal and maternal mortality, preterm birth, birth weight and mode of delivery. Pooled effect sizes were calculated using random-effects meta-analysis. There were significantly increased odds of women from lower levels of occupation/social classes compared with the highest level having stillbirth (OR 1.40, 95% CI 1.23 to 1.59, I2 98.62%), neonatal mortality (OR 1.39, 95% CI 1.22 to 1.57, I2 97.09%), perinatal mortality (OR 1.39, 95% CI 1.23 to 1.57, I2 98.69%), preterm birth (OR 1.41, 95% CI 1.33 to 1.50, I2 70.97%) and low birth weight (OR 1.40, 95% CI 1.19 to 1.61, I2 99.85%). Limitations relate to available data, unmeasured confounders and the small number of studies for some outcomes.

Conclusions This review identified consistent evidence that lower occupational status, especially manual occupations and unemployment, were significantly associated with increased risk of multiple adverse pregnancy outcomes. Strategies to improve pregnancy outcomes should incorporate approaches that address wider determinants of health to provide women and families with the best chances of having a healthy pregnancy and baby and to decrease pregnancy-related health inequalities in the general population.

PROSPERO registration number PROSPERO CRD42019140893.

  • epidemiology
  • maternal medicine
  • fetal medicine
  • public health

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See:

Statistics from

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.

Supplementary materials

  • Supplementary Data

    This web only file has been produced by the BMJ Publishing Group from an electronic file supplied by the author(s) and has not been edited for content.


  • Contributors AM, AJ, JB, SW, CB, HB, NH and JR conceived the study idea and developed the proposal. CR developed the search strategy with contributions from KT, OA, NH, JR, CB, AJ and SW. CR, KT, OA and AO carried out the database searches and supplementary searches. KT, OA, MM, AO and NH completed the screening, data extraction and quality appraisals. MM ran the meta-analysis with support from NH and HB. KT and NH wrote the first draft of the manuscript. All authors edited drafts of this article and approved the final version. The corresponding author attests that all listed authors meet authorship criteria and that no others meeting the criteria have been omitted. NH is the guarantor.

  • Funding The review was commissioned by Public Health Wales. Three public health consultants from Public Health Wales are authors on the paper.

  • Competing interests All authors have completed the ICMJE uniform disclosure form at and declare: support from Public Health Wales for the submitted work; AJ, SW, JB and AM are all employees of Public Health Wales.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement All data relevant to the study are included in the article or uploaded as supplementary information.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.