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Socioeconomic disparities in the postnatal growth of preterm infants: a systematic review
Krithi Ravi1,2, Aneurin Young2,3, R Mark Beattie4
1Department of Anaesthesia, Royal Alexandra Hospital, NHS Greater Glasgow and Clyde, Paisley, UK.
Insights
Low socioeconomic status may negatively impact preterm infant growth, potentially increasing health disparities. Further research is needed to understand these effects and develop interventions for better infant development.
Area of Science:
- Pediatrics
- Public Health
- Health Equity
Background:
- Parental socioeconomic status (SES) is a known determinant of child health.
- Preterm infants face unique challenges in postnatal growth and development.
- Understanding SES impacts on preterm growth is crucial for addressing health inequities.
Purpose of the Study:
- To systematically review the existing literature on the effect of parental SES on the postnatal growth of preterm infants.
- To assess the quality of evidence and health equity implications of studies examining this association.
Main Methods:
- A comprehensive systematic review of four major databases (Medline, Embase, CINAHL Plus, Web of Science) was conducted.
- Included studies published between 1946 and 2023, focusing on anthropometric growth outcomes for preterm infants stratified by parental SES.
- Data extraction, bias assessment, and health equity impact evaluations were performed using standardized forms.
Main Results:
- Twelve studies met the inclusion criteria, primarily focusing on moderate to late preterm infants.
- Six studies indicated an adverse effect of low parental SES on extrauterine growth; five found no effect, and one suggested a potential benefit.
- All included studies exhibited a high risk of bias, particularly concerning confounding and selection bias, with a largely negative health equity impact.
Conclusions:
- Limited, low-quality evidence suggests socioeconomic factors may adversely affect preterm infant growth, exacerbating health inequities.
- There is a need for high-quality observational studies exploring mechanistic pathways linking socioeconomic status to adverse growth outcomes in preterm infants.
- Future research should aim to identify specific targets for interventions to mitigate these disparities and improve long-term health outcomes.
Objective:
To determine the effect of parental socioeconomic status (SES) on the postnatal growth of preterm infants.
Methods:
A systematic review (PROSPERO registration CRD42020225714) of original articles from Medline, Embase, CINAHL Plus and Web of Science published 1946-2023 was undertaken. Studies were included if they reported anthropometric growth outcomes for preterm infants according to parental SES. Data extraction and assessments of bias and health equity impact were conducted using custom-designed forms.
Results:
A narrative synthesis of twelve included studies was performed. Most infants were moderate to late preterm. The settings, growth outcomes, timings of growth measurement, and SES measures were heterogenous. Six studies demonstrated an adverse effect of low parental SES on the extrauterine growth of preterm infants, five studies showed no effect, and one study showed a potentially beneficial effect. All studies had a high risk of bias, especially confounding and selection bias. The health equity impact of included studies was largely negative.
Conclusion:
Limited and low-quality evidence suggests that socioeconomic minoritisation may adversely impact the growth of preterm infants, thereby widening existing socioeconomic health inequities. Observational studies informed by theorisation of the mechanistic pathways linking socioeconomic minoritisation to adverse postnatal growth are required to identify targets for intervention.
Impact:
Limited evidence suggests low parental socioeconomic status (SES) adversely affects the postnatal growth of preterm infants across different settings. Early growth of preterm infants predicts neurodevelopmental outcomes and the risk of cardiovascular and metabolic disease in adulthood. Systematic screening of over 15,000 articles identified only twelve studies which reported postnatal growth outcomes for preterm infants according to parental SES. The health equity impact of the included studies was systematically assessed, and found to be negative overall. This study highlights limitations in existing evidence on the association between parental SES and postnatal growth, and delineates avenues for future research.
