Precarity and pregnancy in Paris

Area of Science:

• Perinatal health
• Social determinants of health
• Public health policy

Background:

• Health insurance, or Social Security, is crucial for accessing healthcare services.
• Socioeconomic factors significantly influence pregnancy outcomes.
• Understanding the impact of Social Security absence on perinatal health is vital for public health interventions.

Purpose of the Study:

• To determine if the lack of Social Security affects pregnancy outcomes.
• To compare perinatal outcomes among pregnant women with and without Social Security.
• To identify other precarity factors influencing pregnancy outcomes.

Main Methods:

• A prospective, population-based study design was employed.
• Compared perinatal outcomes of women without Social Security (n=243) to a control group (n=243).
• Included a third group of women with Social Security but facing child-mother separation (n=32).

Main Results:

• Women without Social Security had fewer and later prenatal consultations.
• No significant differences were observed in maternal morbidity, mortality, delivery modes, low birth weight, fetal death, or neonatal morbidity between women with and without Social Security.
• The group with Social Security and child-mother separation showed significantly higher rates of fetal growth retardation, prematurity, home delivery, C-sections, neonatal drug withdrawal, and NICU transfers.

Conclusions:

• Absence of Social Security during pregnancy is not a primary determinant of poor pregnancy outcomes.
• Other factors of social precarity, such as judicial child-mother separation, are more influential on perinatal health.
• Targeting broader social determinants of health is crucial for improving pregnancy outcomes.