The Role of Poverty-Related Social Determinants in Maternal and Perinatal Health Inequities: A cross-sectional study using the eLIXIR Born in South London, UK maternity-child data linkage

Background: Despite longstanding recognition of health inequities in UK maternity care, evidence remains limited on how intersecting poverty-related social determinants contribute to adverse perinatal outcomes at the population level. While individual factors such as ethnicity and deprivation have been linked to poor outcomes, few studies have examined wider determinants of heath and their cumulative effects using routinely collected data. This study addresses that gap by analysing structural and intermediary poverty-related factors and their association with adverse perinatal outcomes in a large, diverse urban cohort. Methods: We conducted a retrospective cross-sectional analysis of 67,308 pregnancies from the Early Life Cross Linkage in Research (eLIXIR) cohort, using linked electronic health records from NHS Trusts in South London. Structural and intermediary poverty-related variables were assessed using the World Health Organisation’s social determinants framework. The primary outcome was a composite of adverse perinatal events: emergency caesarean, obstetric haemorrhage, preterm birth, low birthweight, low Apgar score, stillbirth, and neonatal death. Binary logistic regression with random intercepts accounted for repeated pregnancies. Adjusted risk ratios were estimated controlling for key sociodemographic and clinical factors. Results: Women from Black (aRR 1.50, 95% CI 1.42–1.59), Asian (aRR 1.49, 95% CI 1.39–1.59), and other non-White ethnic backgrounds (aRR 1.50, 95% CI 1.42–1.59), those living in the most deprived areas (aRR 1.10, 95% CI 1.01–1.20), non-UK-born women (aRR 1.20, 95% CI 1.15–1.25), and recent migrants (aRR 1.32, 95% CI 1.14–1.53) were at significantly higher risk of adverse outcomes. Intermediary factors, e.g., lack of social support (aRR 1.21, 95% CI 1.02–1.42), unemployment (aRR 1.16, 95% CI 1.10–1.23), financial hardship (aRR 1.17, 95% CI 1.01–1.35), living in social housing (aRR 1.16, 95% CI 1.09–1.24), transfer of care between hospitals (aRR 1.27, 95% CI 1.18–1.37), missed appointments (aRR 1.19, 95% CI 1.04–1.37), and unscheduled maternity care use (aRR 1.21, 95% CI 1.14–1.29), were independently associated with increased risk. Moreover, women facing multiple overlapping social risk factors had a significantly higher likelihood of adverse outcomes (aRR 1.23, 95% CI 1.12–1.35), highlighting the cumulative impact of social vulnerability beyond clinical risk. Conclusions: Poverty-related determinants at both structural and intermediary levels substantially shape maternal and perinatal outcomes. Integrated, cross-sector approaches are needed to address these inequalities and improve outcomes for marginalised women and their infants.