title: Risk and protective factors for pregnancy outcomes for urban Aboriginal and non-Aboriginal mothers and infants: the Gudaga cohort.
abstract: This paper aims to describe delivery and birth outcomes of Aboriginal infants and their mothers in an urban setting on the east coast of Australia. The paper uses a causal pathway approach to consider the role of risk and protective factors for low birthweight. All mothers who delivered at Campbelltown Hospital between October 2005 and May 2007 were eligible. The study included 1,869 non-Aboriginal infants and 178 Aboriginal infants and their mothers. Information on delivery and birthweight was extracted from electronic medical records. Risk factors for poor outcomes were explored using regression and causal pathway analysis. Mothers of Aboriginal infants were younger than mothers of non-Aboriginal infants, and were more likely to be single, less educated, unemployed prior to pregnancy, and live in a disadvantaged neighbourhood. Health and service use was similar. They were significantly more likely to have a vaginal delivery than mothers of non-Aboriginal infants (77% cf 62.5%; χ                            (1)                                      (2)                          = 14.6, P < 0.001) and less likely to receive intervention during delivery. Aboriginal infants (3,281.1 g) weighed 137.5 g (95%CI: 54-221 g; P = 0.001) less then non-Aboriginal infants (3,418.7 g). Gestational age, and single mother with incomplete education, prior unemployment, smoking, and living in a disadvantaged neighbourhood were associated with lower birthweight. Maternal vulnerability had a cumulative impact on birthweight. A causal pathway analysis demonstrated the associations between risk factors.
authors.affiliation: Centre for Primary Health Care and Equity, Faculty of Medicine, University of New South Wales, Sydney, NSW 2132, Australia. E.Comino@unsw.edu.au
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Comino
authors.forename: Jennifer
authors.initials: J
authors.lastname: Knight
authors.forename: Vana
authors.initials: V
authors.lastname: Webster
authors.forename: Lisa Jackson
authors.initials: LJ
authors.lastname: Pulver
authors.forename: Bin
authors.initials: B
authors.lastname: Jalaludin
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Harris
authors.forename: Pippa
authors.initials: P
authors.lastname: Craig
authors.forename: Dennis
authors.initials: D
authors.lastname: McDermott
authors.forename: Richard
authors.initials: R
authors.lastname: Henry
authors.forename: Mark
authors.initials: M
authors.lastname: Harris
mesh_terms: D000328:Adult; D001315:Australia / Q000453:epidemiology; D001724:Birth Weight; D015331:Cohort Studies; D036861:Delivery, Obstetric / Q000706:statistics & numerical data*; D005260:Female; D005865:Gestational Age; D006786:Hospitals, Urban / Q000706:statistics & numerical data*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D016015:Logistic Models; D008297:Male; D008423:Maternal Age; D009035:Mothers; D015999:Multivariate Analysis; D011247:Pregnancy; D011256:Pregnancy Outcome / Q000208:ethnology*; D012111:Residence Characteristics; D012307:Risk Factors; D012907:Smoking / Q000009:adverse effects; D012959:Socioeconomic Factors; D014505:Urban Population; D044465:White People / Q000706:statistics & numerical data*; D055815:Young Adult