Lifecourse Socioeconomic Status and High-Risk Pregnancy in Chinese Women: Evidence From Grandmothers, Mothers, and Their Children's Health Study.

Abstract

The increasing proportion of women with high-risk pregnancy has been highlighted as an important public health challenge. This study examined the associations between maternal socioeconomic status during childhood, young adulthood, and married life and the risk of the spectrum of high-risk pregnancy in Chinese pregnant women. This study used data from the Grandmothers, Mothers, and Their Children's Health study, which was conducted in Huai'an city, China, from 2020 to 2021 and included 8,407 married pregnant women. High-risk pregnancy was defined according to the Five-Color Management framework by linking to the Maternity Information System. Maternal socioeconomic status across the life course was constructed using the educational levels of maternal parents, maternal family economic status at age 18 years (referring to parents' economic status), maternal educational level, maternal occupation, husband's educational level, and annual household income. Logistic regression models, the Shapley value decomposition, and the serial mediation model were used. Analyses were conducted in 2024. There were dose-response associations between socioeconomic status scores and high-risk pregnancy at each stage of maternal life, including childhood, young adulthood, and married life (p for trend<0.05). Married life socioeconomic status accounted for 79.59% of the model's explanatory power, followed by young adulthood (10.84%) and childhood socioeconomic status (9.57%). Compared with those with consistently high socioeconomic status, women with consistently low socioeconomic status had higher odds of developing high-risk pregnancy (OR=1.63, 95% CI=1.32, 2.01). Women with lower socioeconomic status across their life-course, particularly those with consistently low socioeconomic status, have a higher risk of high-risk pregnancy. Married life socioeconomic status accounts for the largest portion of the explanatory power of the model. Reducing socioeconomic inequalities from a life-course perspective and promoting universal access to healthcare resources should be considered in the implementation of universal two-child and three-child policies in China.