Maternal residence in urban, rural and island communities and the risk of adverse pregnancy outcomes in Scotland
Clemens, T. (2015) 16th International Medical Geography Symposium, Vancouver, Canada, 6 - 10 July 2015 [SLS]
Adverse birth outcomes, which are important determinants of a number of later life outcomes, have been shown to be associated with both social and environmental characteristics of the mother’s area of residence. However the degree to which pregnancy outcomes vary between urban, rural and island areas remains relatively understudied. Existing evidence from North America shows that rural areas have been associated with poorer outcomes at birth mostly due to the increased levels of poverty and poorer access to services in these areas. The few studies conducted in Europe on the other hand seem to show a protective rural effect for birth outcomes, perhaps via a reduced stress type pathway, while very few studies have looked at island communities specifically. In this study we use routinely collected maternity inpatient records linked to census data and other environmental datasets to examine whether birth weight varies between urban and rural and island and mainland communities in Scotland whilst adjusting for possible confounding by socio-economic status (SES) and characteristics of the physical environment. We highlight two main findings; firstly that maternal residence in an island community has a large and significant protective effect on birth weight independently of effects due to urban and rural environment and other factors and, secondly, that this effect appears to be related to the ‘remoteness’ of island communities. Potential explanations for the findings will be explored and discussed during the presentation.