Dutch nationwide registry study to identify spatial, contextual and environmental inequalities in birth outcomes

The first 1000 days of life, from conception to age 2, are crucial for a child's development, with lasting health impacts. Evidence is growing that environmental and social factors, especially the neighbourhood of birth, play a significant role in shaping health during this period. This study investigates perinatal health disparities in 20 high-risk Dutch neighbourhoods identified by the governmental National Program on Livability and Safety and outlines an initiative to develop tools aimed at reducing geographical health inequalities and improving birth outcomes.

Using data from the national perinatal registry (Perined) from 2015 to 2021, we analysed perinatal outcomes in 1 118 022 mother-child pairs, including perinatal mortality (24 weeks gestation to 7 days postbirth), small for gestational age (SGA; birthweight <10th percentile, corrected for gestational age and sex) and preterm birth (<37 weeks). Three-step logistic regression compared outcomes across all high-risk areas versus the rest of the country, each high-risk area versus national levels and each area versus its municipality, adjusting for confounders and multiple testing.

We observed that SGA (OR 1.19 (95% CI 1.16 to 1.21)), preterm birth (OR 1.09 (95% CI 1.06 to 1.12)) and perinatal mortality (OR 1.13 (95% CI 1.02 to 1.24)) were significantly higher within high-risk areas compared with the rest of the Netherlands. These disparities persisted across the various comparisons.

Living in high-risk neighbourhoods, as defined by livability and safety parameters, is linked to adverse birth outcomes, underscoring the need for targeted, location-based policies. Our collaborative initiative aims to co-develop a knowledge agenda with key stakeholders to create actionable tools that reduce health inequalities from birth.