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Non-medical determinants of perinatal health: protocol for a systematic review with meta-analysis
  1. Leonie A Daalderop1,2,
  2. Marjolein W de Groot1,
  3. Lindsey van der Meer1,
  4. Eric A P Steegers1,
  5. Loes C M Bertens1
  1. 1 Department of Obstetrics and Gynaecology, Erasmus MC, Rotterdam, The Netherlands
  2. 2 Dutch Research Institute for Transitions, Erasmus University Rotterdam, Rotterdam, The Netherlands
  1. Correspondence to Leonie A Daalderop; l.daalderop{at}


Introduction Research focusing on the associations between non-medical determinants and unfavourable perinatal health outcomes is increasing. Despite increasing knowledge on this theme, it still remains unclear to what extent social, environmental and lifestyle factors contribute to these unfavourable outcomes. Therefore, we aim to provide a systematic review, preferably with meta-analysis, in order to provide insight into the associations between non-medical determinants and perinatal mortality, preterm birth and being small for gestational age (SGA).

Methods and analysis Observational studies performed in European countries studying the associations between non-medical determinants and unfavourable perinatal health outcomes will be included. Primary outcomes of interest are perinatal mortality, preterm birth and SGA. To retrieve potential eligible articles, a systematic literature search was performed in the following online databases on 5 October 2018: MEDLINE, Embase, Web of Science, Cochrane and Google Scholar. Additionally, a reference list check and citation search will be performed. Data of the included articles will be extracted using a standardised and piloted data extraction form. Risk of bias will be assessed using the Newcastle-Ottawa Scale. The study selection and data extraction process will be performed by two reviewers independently. Disagreements will be resolved through discussion with a third reviewer. The pooled effects will be calculated separately for each association found between one of the outcome measures and the non-medical determinants using a random effects model. Heterogeneity of the studies will be assessed using the I2 statistic.

Ethics and dissemination No ethical approval is necessary for a systematic review with meta-analysis. The findings will be published in a peer-reviewed journal.

PROSPERO registration number CRD42018056105.

  • perinatal health
  • social determinants of health
  • systematic review
  • meta-analysis
  • non-medical determinants

This is an open access article distributed in accordance with the Creative Commons Attribution 4.0 Unported (CC BY 4.0) license, which permits others to copy, redistribute, remix, transform and build upon this work for any purpose, provided the original work is properly cited, a link to the licence is given, and indication of whether changes were made. See:

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  • Contributors EAPS, LCMB and MWdG conceived this systematic review with meta-analysis. LAD and MWdG developed and drafted the protocol. MWdG registered the protocol in PROSPERO. EAPS, LCMB and LvdM reviewed the protocol and provided extensive feedback. All authors read and approved the final manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Not required.

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

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