title: Socioeconomic inequalities in outcome of pregnancy and neonatal mortality associated with congenital anomalies: population based study.
abstract: OBJECTIVE
  To investigate socioeconomic inequalities in outcome of pregnancy and neonatal mortality associated with congenital anomalies.
  
  
  METHODS
  Retrospective population based registry study.
  
  
  METHODS
  East Midlands and South Yorkshire regions of England (representing about 10% of births in England and Wales).
  
  
  METHODS
  All registered cases of nine selected congenital anomalies with poor prognostic outcome audited as part of the United Kingdom's fetal anomaly screening programme with an end of pregnancy date between 1 January 1998 and 31 December 2007.
  
  
  METHODS
  Socioeconomic variation in the risk of selected congenital anomalies; outcome of pregnancy; incidence of live birth and neonatal mortality over time. Deprivation measured with the index of multiple deprivation 2004 at super output area level.
  
  
  RESULTS
  There were 1579 fetuses registered with one of the nine selected congenital anomalies. There was no evidence of variation in the overall risk of these anomalies with deprivation (rate ratio for the most deprived 10th with the least deprived 10th: 1.05, 95% confidence interval 0.89 to 1.23). The rate ratio varied with type of anomaly and maternal age (deprivation rate ratio adjusted for maternal age: 1.43 (1.17 to 1.74) for non-chromosomal anomalies; 0.85 (0.63 to 1.15) for chromosomal anomalies). Of the nine anomalies, 86% were detected in the antenatal period, and there was no evidence that this varied with deprivation (rate ratio 0.99, 0.84 to 1.17). The rate of termination after antenatal diagnosis of a congenital anomaly was lower in the most deprived areas compared with the least deprived areas (63% v 79%; rate ratio 0.80, 0.65 to 0.97). Consequently there were significant socioeconomic inequalities in the rate of live birth and neonatal mortality associated with the presence of any of these nine anomalies. Compared with the least deprived areas, the most deprived areas had a 61% higher rate of live births (1.61, 1.21 to 2.15) and a 98% higher neonatal mortality rate (1.98, 1.20 to 3.27) associated with a congenital anomaly.
  
  
  CONCLUSIONS
  Antenatal screening for congenital anomalies has reduced neonatal mortality through termination of pregnancy. Socioeconomic variation in decisions regarding termination of pregnancy after antenatal detection, however, has resulted in wide socioeconomic inequalities in liveborn infants with a congenital anomaly and subsequent neonatal mortality.
authors.affiliation: Department of Health Sciences, University of Leicester, UK. lks1@leicester.ac.uk
authors.forename: Lucy K
authors.initials: LK
authors.lastname: Smith
authors.forename: Judith L S
authors.initials: JL
authors.lastname: Budd
authors.forename: David J
authors.initials: DJ
authors.lastname: Field
authors.forename: Elizabeth S
authors.initials: ES
authors.lastname: Draper
mesh_terms: D000028:Abortion, Induced / Q000401:mortality; D000013:Congenital Abnormalities / Q000175:diagnosis / Q000401:mortality*; D004739:England / Q000453:epidemiology; D005260:Female; D054625:Healthcare Disparities / Q000706:statistics & numerical data; D006801:Humans; D007223:Infant; D007226:Infant Mortality; D011247:Pregnancy; D011256:Pregnancy Outcome / Q000453:epidemiology*; D011296:Prenatal Diagnosis / Q000401:mortality / Q000706:statistics & numerical data; D012189:Retrospective Studies; D012959:Socioeconomic Factors