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The effect of neighbourhood income and deprivation on pregnancy outcomes in Amsterdam, The Netherlands
  1. C Agyemang1,
  2. T G M Vrijkotte1,
  3. M Droomers2,
  4. M F van der Wal3,
  5. G J Bonsel4,
  6. K Stronks1
  1. 1
    Department of Social Medicine, Academic Medical Centre, University of Amsterdam, The Netherlands
  2. 2
    Centre for Prevention and Health Services Research; National Institute for Public Health and the Environment, Bilthoven, The Netherlands
  3. 3
    Municipal Health Service, Department of Epidemiology, Documentation and Health Promotion, Amsterdam, The Netherlands
  4. 4
    Institute of Health Policy and Management, Erasmus MC Rotterdam, Rotterdam, The Netherlands
  1. Correspondence to Dr C Agyemang, Dept. of Social Medicine, Academic Medical Centre, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands; c.o.agyemang{at}


Background: Studies suggest that the neighbourhoods in which people live influence their health. The main objective of this study was to investigate the associations of neighbourhood-level income and unemployment/social security benefit on pregnancy outcomes: preterm delivery, small for gestational age (SGA), pregnancy-induced hypertension (PIH) and miscarriage/perinatal death in Amsterdam.

Methods: A random sample of 7883 from 82 neighbourhoods in Amsterdam. Individual-level data from the Amsterdam Born Children and their Development (ABCD) study were linked to data on neighbourhood-level factors. Multilevel logistic regression was used to estimate odds ratios and neighbourhood-level variance.

Results: After adjustment for individual-level factors, women living in low-income neighbourhoods (third, second and first quartiles) were more likely than women living in high-income neighbourhoods (fourth quartile) to have SGA births: OR 1.32 (95% CI 1.04 to 1.68), 1.42 (1.11 to 1.82) and 1.62 (1.25 to 2.08) respectively. Women living in the quartile of neighbourhoods with the highest unemployment/social security benefit were more likely than those living in the quartile with the lowest unemployment/social security benefit to have SGA births 1.36 (1.08 to 1.72). The neighbourhood-level variance was significant only for SGA births. No significant associations were found between neighbourhood-level factors and other pregnancy outcomes.

Conclusion: The findings suggest that neighbourhood income and deprivation are related to SGA births. More research is needed to explore possible mechanisms underlying poor neighbourhood environment and pregnancy outcomes, in particular through stress mechanisms. Such information might be necessary to help improve maternal and fetal health.

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  • Funding C. Agyemang was supported by a VENI fellowship (grant number 916.76.130) awarded by the Board of the Council for Earth and Life Sciences (ALW) of The Netherlands Organisation for Scientific Research (NWO).

  • Competing interests None.

  • Ethics approval The study protocol was approved by the medical ethical committees of all Amsterdam hospitals and the Municipal Privacy Protection Committee of Amsterdam.