Geographical divergence in pregnancy and neonatal outcomes in Sweden – identifying small areas for targeted public health interventions and individual medical screening and prevention strategies

Preterm birth is critical for neonatal survival; it is the leading cause of perinatal mortality, infant morbidity and, globally, death under five years of age.

Even if significant advances have been made in preterm born babies´ care, there is still a risk for long-term health problems.

The economic impact is noteworthy; only in Sweden, where the prevalence of preterm delivery is one of the lowest in the world, society still pays at least 32 billion SEK for each yearly cohort of children born preterm and up to 18-years of age.There are substantial differences in the preterm birth rates across high-income countries.

In a recent international project, we assessed the different contributions of known risk factors to preterm delivery rates. We found that they only explained a small part of the overall variation. In a follow-up project, we found a considerable variation within Sweden (three times difference). The variation observed is as large as that between countries.

This shows us that the preterm birth rate can also be substantially lowered in a country like Sweden.

This project will explore the geographical and temporal differences in pregnancy and child outcomes in Sweden and identify possible individual and contextual causes. Our focus will be preterm delivery, pregnancy complications, perinatal mortality, and neonatal morbidity. Sociodemographic and contextual models will be the primary exposures based on so-called "geomapping".

Utilizing the Swedish Medical Birth Registry, Multigenerational Registry, different Quality Registries, and data from Statistics Sweden.

Our main aim is to understand better how sociodemographic and contextual factors affect pregnancy and child outcomes in different parts of Sweden.

These findings will improve equity within Sweden by enabling essential improvements to public health organizations, interventions, and possibly antenatal care.The study´s findings will help improve equity in Sweden by identifying and formulating primary preventive strategies in public health and medical screening to improve pregnancy and child outcomes in antenatal clinics.