Maternal Morbidity in Different Socioeconomic Classes in Southwest of Iran; A Prospective Cohort Study

Background: Globally, maternal morbidity is a major public health concern as some estimates suggest that about 10 million women worldwide suffer from pregnancy-related complications each year. It seems that socioeconomic status is an important factor effects on these complications. The impact can vary from one class to another. Because of the differences in socioeconomic status hence, this study examined the impact of socioeconomic status on maternal postpartum complications.Methods: A nested case-control design was applied to clarify the risk of morbidities in mothers after delivery in socioeconomic classes, using of pregnant women cohort database which was started in 2011. A self-administered questionnaire, interview, and medical records were used to collect information on demographic, obstetrical and gynecological history, some information regarding the latest delivery. After getting approval from the Ethics committee of Shiraz University of Medical Sciences, we contacted the mothers 8 weeks after giving birth to their babies. So, we could interview 4267 mothers by phone and asked whether they experienced any morbidity during childbirth or up to 42 days of puerperium. Those who had experience any post-partum morbidities were invited to be visited in a clinic where cohort study was conducted for documenting the mothers’ claim. In this study we considered six severe maternal morbidities: sever vaginal bleeding, delivery site infection, urinary tract infection, unbearable pain, depression, and uterine rupture. The characteristics of women with severe maternal morbidity were described and the association between morbidity andLQGLYLGXDO FKDUDFWHULVWLFV ZDV DVVHVVHG XVLQJ 2 DQDO\VLV. 7KHVH DVVRFLDWLRQV ZHUH IXUWKHU explored using univariable logistic regression to generate ORs and 95% CIs. In all statistical tests, the significance level P < 0.05 was considered. All analysis was done using SPSS version 22 (SPSS Inc., Chicago, IL, USA).Results: We interviewed 4267 mothers, of them 225 (5.5%) belonged to high SES, 2662 (62.4%) to middle SES and 1380 (32.3%) to low SES. We found the highest frequency of severe postpartum morbidities in mothers belonged to middle SES (470; 56.1%), followed by mothers in low SES (334; 39.8%), and then high SES (34; 4.1%). Having accounted for other factors and possible confounders sequentially, the fully adjusted model shows that low SES significantly associated with depression (OR =1.8 CI 95% 1.3 - 2.4), and middle of SES associated with site infection (OR= 1.7 CI 95%; 1.2 - 2.5). Conclusion: This study suggests that SES may be associated with an increased risk of severe maternal morbidity in particular depression and surgical site infection, independent of risks associated with ethnic group or known medical and pregnancy complications. However, the reasons for this possible association remain unclear, suggesting a need, not only to see if the observed association can be reproduced in other populations or settings, but also for further research to investigate whether there are differences in lifestyle and health-seeking behaviour, access to care or the quality of care received by women from different socioeconomic groups