Further information on the causes and risk factors of poor health in children and young people (relating to having the best start in life) are framed around the topic headings listed below. The information on this page presents a general overview of causes and risk factors to poor health in this stage of the lifecourse.

There are a wide variety of factors that influence maternal, perinatal and infant health.1 Figure 2 summarises the most important maternal contributory factors. The Marmot Review commented that:2

‘maternal health, including stress, diet, drug, alcohol and tobacco use during pregnancy, has significant influence on foetal and early brain development’

Figure 2: Maternal factors that influence maternal, perinatal and infant health
Figure 2: Maternal factors that influence maternal, perinatal and infant health

Note: NEET means a young person (age 16-24) not in education, employment or training.

Sources: Risk factors for poor health (white boxes) taken from the Healthy Child Programme report, Pregnancy and the First 5 Years of Life’, 2009; protective factors for good health (light green boxes) taken from the WAVE Trust report Conception to age 2 – the age of opportunity’, 2013.  3 4

From Figure 2 above, it is clear that many of the maternal factors governing perinatal health are interrelated and linked to common underlying ‘causes’. For instance, young parenthood may be a risk factor in its own right, or it may be a marker for educational circumstances. The Marmot Review listed deprivation, births outside of marriage, non-White ethnicity and maternal age under 20 as all being independently associated with an increased risk of infant mortality, in addition to them contributing to the risks outlined above (for instance, deprivation as a factor in maternal diet). 5

The Office for National Statistics (ONS) classifies the causes of death for neonates according to the time and type of abnormality as follows: 6

  • before the onset of labour
    • congenital anomalies – such as cardiovascular anomalies or neural tube defects
    • antepartum infections
    • immaturity related conditions – such as extremely low birthweight or bronchopulmonary dysplasia
  • in or shortly after labour
    • asphyxia, anoxia or trauma
  • post-natal
    • external conditions – such as hypothermia of the newborn
    • Infections

Figure 3 shows the broad categories of causes of infant deaths in London. The underlying causes and risk factors that contribute to these deaths are listed by Public Health England (PHE) as child poverty, teenage pregnancy, access to antenatal care, smoking in pregnancy, maternal and infant nutrition, sudden unexpected deaths in infancy (SUDI) A and vaccinations.

Thirty-four percent relate to congenital abnormalities, fourty-five percent to immaturity-related conditions and twenty-one percent is other.
Figure 3: Causes of infant deaths

Source: Public Health England.7

The wider determinants of maternal, perinatal and infant health are covered in the ‘Society and environment’ JSNA chapter, which describes the main social, economic and environmental influences on health throughout the life course. In addition, Section 5 discusses some of the other causes and risk factors for poor early years health.

The remainder of this section focuses on a number of specific risk factors that impact directly on perinatal health – i.e. maternal age, maternal smoking, maternal weight, maternal mental health and maternal and infant nutrition. However, once again, it is worth noting that many of these factors are interlinked (for instance, teenage mothers are more likely to smoke during pregnancy or have maternal mental health problems).

Notes

  1. SUDI, in turn, has risk factors that include deprivation, low birthweight, mothers aged under 20, bed sharing and smoking.

References

  1. “Conception to age 2 – the age of opportunity,” Wave Trust; Department for Education, 2013.
  2. M. Marmot, “Fair Society Healthy Lives,” University College London, 2010.
  3. NHS Digital, “Antenatal assessments within 13 weeks (CCGOIS 1.13),” December 2015. [Online]. Available: https://data.gov.uk/dataset/antenatal-assessments-within-13-weeks-ccgois-1-13. [Accessed 10 November 2016].
  4. M. Marmot, “Fair Society Healthy Lives,” University College London, 2010.
  5. M. Marmot, “Fair Society Healthy Lives,” University College London, 2010.
  6. N. Dattani and S. Rowan, “Causes of neonatal deaths and stillbirths: a new hierarchical classification in ICD-10,” Office for National Statistics, 2001.
  7. “Gov.uk,” Public Health England, 2015. [Online]. Available: https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/431516/Reducing_infant_mortality_in_London_2015.pdf. [Accessed May 2016].