Maternal health indicators during pregnancy and birth outcomes during times of great macroeconomic instability: the case of Iceland

• Main Author: Eiríksdóttir, Védís Helga
• Other Authors: Unnur A. Valdimarsdóttir, Læknadeild (HÍ), Faculty of Medicine (UI), Heilbrigðisvísindasvið (HÍ), School of Health Sciences (UI), Háskóli Íslands, University of Iceland
• Format: Doctoral or Postdoctoral Thesis
• Language: English
• Published: University of Iceland, School of Health Sciences, Faculty of Medcine 2016
• Subjects: Efnahagskreppur; Heilsuhegðun; Háþrýstingssjúkdómar á meðgöngu; Óhagstæðar fæðingaútkomur; Þjóðhagfræðileg staða; Doktorsritgerðir; Economic recession; Health behavior; Pregnancy induced hypertensive disorders; Adverse birth outcomes; Macroeconomic conditions; Iceland
• Online Access: https://hdl.handle.net/20.500.11815/149

Background and aims: Macroeconomic fluctuations have shown various effects on population health, but the evidence base for their influence on maternal health and birth outcomes is scarce and inconclusive. The overall aim of this thesis was to examine the potential effect of the 2008 economic collapse in Iceland on maternal diseases and health behaviors during pregnancy as well as on adverse birth outcomes. Furthermore, we aimed to explore the effect of the surrounding economic climate in Iceland on potential changes in the health of the pregnant women and birth outcomes. Material and methods: In study I we used a random sample of 1329 births occurring between 2001, and 2010. Information on maternal smoking status, body mass index and demographic characteristics were retrieved from the Icelandic Medical Birth Registry and maternity records. Trends in continued smoking into the second trimester of pregnancy, obesity, and body mass index were assessed using logistic and linear regression analyses. Logistic regression analysis was used to calculate the annual odds of smoking and obesity, both overall and by maternal demographic characteristics. In studies II-IV, the Icelandic Medical Birth Registry was used to identify all women giving birth to live-born singletons between the years 2002 and 2012 (2006- 2009 for study III). Information on pregnancy-induced hypertensive disorders, birth outcomes, and parental demographic characteristics were retrieved from the Birth Registry and use of antihypertensive drugs during pregnancy, including β-blockers and calcium channel blockers, from the Icelandic Medicines Registry. Information on the aggregate economic climate was retrieved from Statistics Iceland. With the pre-recession period as a reference, we used logistic regression analyses to assess changes in pregnancy-induced hypertensive disorders, prescription fills for antihypertensive drugs and adverse birth outcomes during the recession years. Results: There was an annual decrease in continued smoking (odds ratio (OR) ...