Educational differences in perinatal health are persistent in Finland

Background

Nordic countries aim to diminish socio-economic health differences. However, increasing perinatal health differences in stillbirth, infant mortality, prematurity and growth have been reported since the early 2000s.

Methods

The Finnish Medical Birth Register 2002-2023 was linked to the Education Register with mothers’ encrypted personal identity codes (N = 1 186 335 deliveries and 1 203 417 newborns). Education referred to mother’s highest education on 31 December the year before childbirth and divided into three groups: basic (≤9 years), upper secondary education (10-12 years) and tertiary (≥13 years). Perinatal health was measured by five indicators: preterm birth (<37 gestational weeks), low birth weight (<2500 grams), SGA (small-for gestational age), LGA (small/large-for gestational age), and perinatal death (stillbirths and deaths during the first week of living).

Results

Substantial differences were observed between different educational groups. Largest differences were found for maternal age, IVF, smoking and pregnancy history. Differences in mode of delivery were modest but increased after adjustments. For perinatal health, perinatal death and SGA had the largest disparities when comparing women with basic education to those with university education (excess age- and period-adjusted risk 70–84%). The risks were moderate for preterm birth and low-birth weight (30-51%), and small for LGA (8%). By time, excess risk increased for preterm birth and low birth weight, remained similar for perinatal death and SGA and diminished for LGA.

Conclusions

Increased socioeconomic differences in preterm birth and low birth weight are worrisome, since these may also track into socially patterned health inequalities in adulthood. Tackling perinatal health inequalities requires a multi-faceted approach focusing on targeted care for high-risk groups, improved staff training on bias, community-based care models, and robust data collection to monitor disparities.

Key messages

• Socioeconomic differences increased for preterm birth and low birth weight, but remained similar for perinatal death.

• Increased socioeconomic differences may track into socially patterned health inequalities in adulthood.