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Consequently there were significant socioeconomic inequalities in the rate of live birth and neonatal mortality associated with the presence of any of these nine anomalies.Socioeconomic inequalities in congenital anomalies have been shown to exist in the rates of stillbirth and perinatal, neonatal, and infant mortality.1 2 3 4 Research has shown an increasing risk of non chromosomal anomalies with increasing deprivation5 and, in contrast, a decreasing risk of chromosomal anomalies, though this latter finding is predominantly because of the increased risk of chromosomal anomalies with increasing maternal age.5 The influence of socioeconomic deprivation along the pathway from antenatal detection to delivery and possible neonatal mortality, however, is not fully understood because of the lack of rigorous data in the antenatal period. Countries that have introduced the use of prenatal diagnostic techniques and access to termination of pregnancy because of congenital anomaly have seen large reductions in neonatal mortality rates,6 7 8 9 unlike those countries with more restrictive policies on pregnancy termination.10 Nevertheless, the impact of these secondary preventative measures might vary with socioeconomic deprivation in terms of access to, and timing of, antenatal detection services through to the provision of information, the interpretation of risk, and the consequent decision regarding continuation or termination of a pregnancy.Evidence is sparse. A systematic review of studies in the United Kingdom showed no evidence of social inequalities in the uptake of prenatal screening,11 while research in Northern Ireland, where access to termination services is much more restricted, showed inequalities in both the offer and uptake of screening.11 12 Further research suggests that socioeconomic differentials in decision making after antenatal detection are because of differences in maternal age.13 The term “congenital anomaly” covers a wide spectrum from the relatively minor to those with an exceptionally poor prognostic outcome, and it is the latter that will be most affected by secondary preventative measures.We used data from a large congenital anomaly register in England (covering about 10% of the births in England and Wales) for 1998 2007 to investigate socioeconomic inequalities in the risk of congenital anomalies with a poor prognosis from antenatal diagnosis to end of pregnancy.
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