This section describes perinatal and infant health (for definitions, see Box 1) in Hackney and the City of London. Perinatal and infant health are heavily dependent on the health of the mother during and immediately after pregnancy. For this reason, indicators of maternal health are also covered in this section. Key perinatal health outcomes include stillbirths, infant mortality, prematurity and birthweight.
|Perinatal – from 22 weeks gestation until seven days after birth
Infant – from birth until one year of age
Stillbirth – baby born dead after 24 completed weeks of pregnancy (prior to 24 weeks, this is classified as a miscarriage or late foetal loss). 1
Infant mortality rate (IMR) – the number of deaths under the age of one year per 1,000 live births. Consists of the neonatal mortality rate (deaths occurring during the first 28 days of life) and the post-neonatal mortality rate (deaths occurring between 28 days and one year of life). 2
Preterm birth – baby born alive before 37 weeks of pregnancy have been completed. Categories are based on gestation: 3
Low birthweight – birthweight under 2,500g (5.5lb) – shown to be associated with a 20-fold increase in mortality compared to normal or heavier weight babies, as well as a range of later negative health outcomes. 4
The effects of maternal and perinatal health are not just apparent in infancy, but continue into later life, as highlighted in the report of the 2010 Marmot Review report, ‘Fair Society, Healthy Lives’: 5
‘Inequalities present before birth set the scene for poorer health and other outcomes accumulating throughout the life course.’
It can be difficult to quantify the impact of maternal and perinatal health on later health outcomes specifically, as a number of confounding factors are likely to be at play. For instance, children of obese mothers are more likely to be obese themselves. 6 However, it is difficult to disentangle the differential influences of (a) the effects of maternal obesity on the developing foetus during pregnancy, and (b) shared environmental risk factors (such as access to an affordable healthy diet) and/or socio-demographic risk factors for obesity (such as ethnicity or deprivation).
A note on the data: within-area comparisons
Throughout this chapter, data are presented by Hackney and City Children’s Centre areas (depicted in Figure 1), as services for pregnant women and children during the early years are predominantly configured around local Children’s Centres.
A key point to note when interpreting these data is that 22% of Hackney’s children and young people (under 19 years of age) belong to the Stamford Hill Orthodox Jewish community (see Introduction), and that the majority of this community (74%) are concentrated in Children’s Centre area B in the north east of the borough.
Figure 1: Hackney and City Children’s Centre areas, with stars marking centre locations
Source: London Borough of Hackney
- “Stillbirth,” NHS [Online]. Available: https://www.nhs.uk/conditions/stillbirth/ [Accessed Oct 2018].
- “Reducing infant mortality in London,” Public Health England, 2015. [Online]. Available: https://www.gov.uk/government/publications/reducing-infant-mortality-in-london [Accessed Oct 2018].
- “Preterm birth,” World Health Organization, November 2015. [Online]. Available: http://www.who.int/en/news-room/fact-sheets/detail/preterm-birth [Accessed Oct 2018].
- T. Wardlaw, A. Blanc, J. Zupan and E. Ahman, “Low birthweight: country, regional and global estimates,” World Health Organization; UNICEF, 2004. [Online]. Available: https://www.unicef.org/publications/index_24840.html [Accessed Oct 2018].
- M. Marmot, “Fair Society Healthy Lives,” Institute of Health Equity, 2010. [Online]. Available: http://www.instituteofhealthequity.org/resources-reports/fair-society-healthy-lives-the-marmot-review [Accessed Oct 2018].
- “Maternal obesity and child outcomes,” Public Health England, 2015. [Online]. Available: http://webarchive.nationalarchives.gov.uk/20170110171112/https://www.noo.org.uk/NOO_about_obesity/maternal_obesity_2015/child_outcomes [Accessed Oct 2018].
- “The Science of Early Childhood Development: closing the gap between what we know and what we do,” National Scientific Council on the Developing Child, 2007. [Online]. Available: https://developingchild.harvard.edu/resources/the-science-of-early-childhood-development-closing-the-gap-between-what-we-know-and-what-we-do/ [Accessed Oct 2018].
- F. Field, “The Foundation Years: preventing poor children becoming poor adults,” Cabinet Office, 2010. [Online]. Available: https://www.bl.uk/collection-items/foundation-years-preventing-poor-children-becoming-poor-adults-the-report-of-the-independent-review-on-poverty-and-life-chances [Accessed Oct 2018].