title: Socio-demographic inequalities across a range of health status indicators and health behaviours among pregnant women in prenatal primary care: a cross-sectional study.
abstract: BACKGROUND
  Suboptimal maternal health conditions (such as obesity, underweight, depression and stress) and health behaviours (such as smoking, alcohol consumption and unhealthy nutrition) during pregnancy have been associated with negative pregnancy outcomes. Our first aim was to give an overview of the self-reported health status and health behaviours of pregnant women under midwife-led primary care in the Netherlands. Our second aim was to identify potential differences in these health status indicators and behaviours according to educational level (as a proxy for socio-economic status) and ethnicity (as a proxy for immigration status).
  
  
  METHODS
  Our cross-sectional study (data obtained from the DELIVER multicentre prospective cohort study conducted from September 2009 to March 2011) was based on questionnaires about maternal health and prenatal care, which were completed by 6711 pregnant women. The relationships of education and ethnicity with 13 health status indicators and 10 health behaviours during pregnancy were examined using multilevel multiple logistic regression analyses, adjusted for age, parity, number of weeks pregnant and either education or ethnicity.
  
  
  RESULTS
  Lower educated women were especially more likely to smoke (Odds Ratio (OR) 11.3; 95% confidence interval (CI) 7.6- 16.8); have passive smoking exposure (OR 6.9; 95% CI 4.4-11.0); have low health control beliefs (OR 10.4; 95% CI 8.5-12.8); not attend antenatal classes (OR 4.5; 95% CI 3.5-5.8) and not take folic acid supplementation (OR 3.4; 95% CI 2.7-4.4). They were also somewhat more likely to skip breakfast daily, be obese, underweight and depressed or anxious. Non-western women were especially more likely not to take folic acid supplementation (OR 4.5; 95% CI 3.5-5.7); have low health control beliefs (OR 4.1; 95% CI 3.1-5.2) and not to attend antenatal classes (OR 3.3; 95% CI 2.0-5.4). They were also somewhat more likely to have nausea, back pains and passive smoking exposure.
  
  
  CONCLUSIONS
  Substantial socio-demographic inequalities persist with respect to many health-related issues in medically low risk pregnancies in the Netherlands. Improved strategies are needed to address the specific needs of socio-demographic groups at higher risk and the structures underlying social inequalities in pregnant women.
authors.affiliation: Department of Midwifery Science, AVAG and the EMGO Institute for Health and Care Research, VU University Medical Centre, P.O. Box 7057, 1007, MB, Amsterdam, The Netherlands. ruth.baron@inholland.nl.
authors.forename: Ruth
authors.initials: R
authors.lastname: Baron
authors.affiliation: Department of Midwifery Science, AVAG and the EMGO Institute for Health and Care Research, VU University Medical Centre, P.O. Box 7057, 1007, MB, Amsterdam, The Netherlands. judithmannien@gmail.com.
authors.forename: Judith
authors.initials: J
authors.lastname: Manniën
authors.affiliation: Department of Epidemiology and Biostatistics and the EMGO Institute for Health and Care Research, VU University Medical Centre, P.O. Box 7057, 1007, MB, Amsterdam, The Netherlands. s.tevelde@vumc.nl.
authors.forename: Saskia J
authors.initials: SJ
authors.lastname: te Velde
authors.affiliation: Department of Midwifery Science, AVAG and the EMGO Institute for Health and Care Research, VU University Medical Centre, P.O. Box 7057, 1007, MB, Amsterdam, The Netherlands. trudy.klomp@inholland.nl.
authors.forename: Trudy
authors.initials: T
authors.lastname: Klomp
authors.affiliation: Department of Midwifery Science, AVAG and the EMGO Institute for Health and Care Research, VU University Medical Centre, P.O. Box 7057, 1007, MB, Amsterdam, The Netherlands. huttone@mcmaster.ca.|McMaster University, 1280 Main St. W., MDCL 2210, Hamilton, ON, L8S 4 K1, Canada. huttone@mcmaster.ca.
authors.forename: Eileen K
authors.initials: EK
authors.lastname: Hutton
authors.affiliation: Department of Epidemiology and Biostatistics and the EMGO Institute for Health and Care Research, VU University Medical Centre, P.O. Box 7057, 1007, MB, Amsterdam, The Netherlands. j.brug@vumc.nl.
authors.forename: Johannes
authors.initials: J
authors.lastname: Brug
mesh_terms: D000328:Adult; D003430:Cross-Sectional Studies; D004522:Educational Status; D005006:Ethnicity / Q000706:statistics & numerical data*; D005260:Female; D015438:Health Behavior; D007722:Health Knowledge, Attitudes, Practice; D006306:Health Surveys / Q000706:statistics & numerical data*; D006801:Humans; D009426:Netherlands; D011247:Pregnancy; D011295:Prenatal Care / Q000706:statistics & numerical data*; D011446:Prospective Studies; D012907:Smoking / Q000453:epidemiology; D012959:Socioeconomic Factors