Adverse Birth Outcomes as Indicators of Poor Fetal Growth Conditions in a French Newborn Population—A Stratified Analysis by Neighborhood Deprivation Level
Abstract
:1. Introduction
2. Material and Methods
2.1. Study Area
2.2. Individual Data Source
2.3. Parental Characteristics
2.4. Newborn Characteristics
2.5. Neighborhood Characteristics
2.6. Statistical Analysis
- (i)
- whether Model 2 and/or Model 3 fit better than Model 1 in each sub-group, separately, and
- (ii)
- whether the signs, the magnitude and the p-value of the regression coefficients related to FFGC varied between each sub-group (from the most deprived census blocks to the most advantaged).
3. Results
3.1. Population Description
3.2. Main Findings of the Structural Equation Models
- -
- In Model 2, both CFI and [1-RMSEA] values were close to but below the ideal fit of 1, indicating that Model 2 provided a good fit for the data). However, Model 2 had a higher BIC value than the direct model (Model 1) (981.3 vs. 818.8). According to literature recommendations [19], Model 2 did not provide a better fit to the data because the BIC value of Model 2 was higher that the BIC value of the direct model, even if CFI and [1-RMSEA] were close 1).
- -
- Inversely, in Model 3, the addition of direct paths between exogenous variables and birth outcomes improved the model fit. The fit statistics indicate an excellent fit for the data: as with model 2, the CFI and [1-RMSEA] were close to 1. However, a more substantial gap is visible for BIC which, in Model 3, is lower than for Model 1 (780.7 vs. 818.8) and the difference is greater than 10. Model 3, which includes the FFGC latent variable as a mediator variable between the parents characteristics and the birth outcomes (BW, BL, and GA) and includes additional direct paths, appears to be the best model.
3.3. Sensitivity Analysis
- -
- For newborns living in the census blocks categorized in SES8, the measure of parity (FirstP) was not significant; in addition, young mothers and those with a primary level of education were negatively related to FFGC.
- -
- For newborns living in the census blocks categorized in SES7, only the measures of parity (FirstP), maternal age (Older) negatively predicted FFGC (see Supplementary Table S1).
4. Discussion
5. Conclusions
Supplementary Materials
Author Contributions
Acknowledgments
Conflicts of Interest
References
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N | Point Estimate | Standard Deviation | Minimum | Maximum | |
---|---|---|---|---|---|
Newborns’ characteristics | |||||
Birth weight (grs) | 105,346 | 3314 | 499 | 540 | 5800 |
Birth length (cms) | 102,589 | 49.7 | 2.3 | 25 | 60 |
gestational age (weeks) | 105,346 | 39.1 | 1.6 | 23 | 45 |
gender-girl (%) | 105,346 | 49.3 | |||
Parents’ characteristics | |||||
Parity (%) | 104,461 | 39.2 | |||
Unemployed mother (%) | 105,346 | 45.2 | |||
Unemployed father (%) | 105,346 | 37.1 | |||
Age | 105,346 | ||||
younger (<20 years) (%) | 632 | 0.6% | |||
Middle (20–35 years) (%) | 73,637 | 69.9% | |||
Older (≥35 years) (%) | 31,077 | 29.5% | |||
Level of education | 105,346 | ||||
Higher (%) | 49,584 | 47.1% | |||
bac (%) | 6005 | 5.7% | |||
Secondary (%) | 3867 | 3.7% | |||
Primary (%) | 45,890 | 43.6% |
Model | Chi2 | df | p-Value | SRMR | RMSEA | [1-RMSEA] | BIC | CFI |
---|---|---|---|---|---|---|---|---|
Model 1 | 11.6423 | 8 | <0.0001 | 0.0012 | 0.0021 | 0.9979 | 818.8 | 1 |
Model 2 | 335.5241 | 22 | <0.0001 | 0.0058 | 0.0118 | 0.9882 | 981.2 | 0.9988 |
Model 3 | 88.8684 | 18 | <0.0001 | 0.0022 | 0.0062 | 0.9938 | 780.7 | 0.9997 |
Parents’ Characteristics | β | SE | p-Value |
---|---|---|---|
FirstP | −0.03771 | 0.00360 | <0.0001 |
unemployedF | −0.02396 | 0.00682 | 0.0004 |
unemployedM | 0.00959 | 0.00473 | 0.0425 |
Age | |||
Younger | −0.01913 | 0.00335 | <0.0001 |
Middle | ref | --- | --- |
Older | −0.01871 | 0.00338 | <0.0001 |
Level of education | |||
Higher | ref | --- | --- |
bac | −0.02233 | 0.00344 | <0.0001 |
Secondary | −0.02971 | 0.00344 | <0.0001 |
Primary | −0.05511 | 0.00427 | <0.0001 |
The Least Deprived Census Blocks | The Most Deprived Census Blocks | |||||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|
Parents’ Charactéristics | SES1 (10,567) | SES2 (10,449) | SES9 (10,523) | SES10 (10,513) | ||||||||
β | SE | p-Value | β | SE | p-Value | β | SE | p-Value | β | SE | p-Value | |
Firstp | −0.05445 | 0.01134 | <0.0001 | −0.05202 | 0.01144 | <0.0001 | −0.04178 | 0.01129 | 0.0002 | −0.03433 | 0.01120 | 0.0022 |
Unemployedf | 0.00630 | 0.02126 | 0.7670 | −0.01342 | 0.02176 | 0.5373 | −0.05573 | 0.02030 | 0.0061 | −0.03872 | 0.01843 | 0.0357 |
Unemployedm | 0.02707 | 0.01392 | 0.0519 | 0.02548 | 0.01418 | 0.0724 | 0.00415 | 0.01430 | 0.7716 | −0.01126 | 0.01363 | 0.4087 |
Age of the Mother | ||||||||||||
Younger | 0.0008263 | 0.01059 | 0.9378 | −0.00335 | 0.01066 | 0.7534 | −0.02141 | 0.01057 | 0.0429 | −0.01962 | 0.01061 | 0.0644 |
Middle | ref | -- | -- | ref | -- | -- | ref | -- | -- | ref | -- | -- |
Older | −0.03073 | 0.01075 | 0.0042 | −0.02165 | 0.01084 | 0.0458 | −0.02846 | 0.01064 | 0.0075 | −0.01248 | 0.01061 | 0.2396 |
Level of Mother Education | ||||||||||||
Superior | ref | -- | -- | ref | -- | -- | ref | -- | -- | ref | -- | -- |
bac | −0.03120 | 0.01063 | 0.0033 | −0.01657 | 0.01075 | 0.1230 | −0.03449 | 0.01136 | 0.0024 | −0.03278 | 0.01207 | 0.0066 |
Secondary | −0.02233 | 0.01065 | 0.0359 | −0.01907 | 0.01077 | 0.0766 | −0.03335 | 0.01130 | 0.0032 | −0.04767 | 0.01196 | <0.0001 |
Primary | −0.05553 | 0.01261 | <0.0001 | −0.07422 | 0.01286 | <0.0001 | −0.05797 | 0.01384 | <0.0001 | −0.04571 | 0.01468 | 0.0019 |
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Kihal-Talantikite, W.; Le Nouveau, P.; Legendre, P.; Zmirou Navier, D.; Danzon, A.; Carayol, M.; Deguen, S. Adverse Birth Outcomes as Indicators of Poor Fetal Growth Conditions in a French Newborn Population—A Stratified Analysis by Neighborhood Deprivation Level. Int. J. Environ. Res. Public Health 2019, 16, 4069. https://doi.org/10.3390/ijerph16214069
Kihal-Talantikite W, Le Nouveau P, Legendre P, Zmirou Navier D, Danzon A, Carayol M, Deguen S. Adverse Birth Outcomes as Indicators of Poor Fetal Growth Conditions in a French Newborn Population—A Stratified Analysis by Neighborhood Deprivation Level. International Journal of Environmental Research and Public Health. 2019; 16(21):4069. https://doi.org/10.3390/ijerph16214069
Chicago/Turabian StyleKihal-Talantikite, Wahida, Pauline Le Nouveau, Pierre Legendre, Denis Zmirou Navier, Arlette Danzon, Marion Carayol, and Séverine Deguen. 2019. "Adverse Birth Outcomes as Indicators of Poor Fetal Growth Conditions in a French Newborn Population—A Stratified Analysis by Neighborhood Deprivation Level" International Journal of Environmental Research and Public Health 16, no. 21: 4069. https://doi.org/10.3390/ijerph16214069