Change in maternal income status following stillbirth, neonatal death and severe neonatal morbidity

Aim — We evaluated whether stillbirth, neonatal death or severe neonatal morbidity is associated with a mother’s change in residential neighbourhood income between two consecutive births.

Methods — This population-based cohort included all mothers in Ontario, Canada with two consecutive births at 20–42 weeks’ gestation, 2003–2023. The study exposure at the first birth was: (i) livebirth unaffected by severe neonatal morbidity or neonatal death (referent); (ii) livebirth with severe neonatal morbidity but no neonatal death; (iii) livebirth with neonatal death; and (iv) stillbirth. The study outcome was a mother’s change in residential neighbourhood income quintile (Q) between two consecutive births: (i) downward income mobility, (ii) upward income mobility, or (iii) persistently residing in the lowest income Q1 at each birth. — each relative to iv) no change in neighbourhood income Q between births (referent).

Results — There were 720,119 mothers included. Among those initially residing in income Q2-5, relative to those with an unaffected livebirth, there was a higher likelihood of downward income mobility between births if their child was affected by non-fatal severe neonatal morbidity (aOR 1.05, 95% CI 1.02-1.08). Among mothers initially residing in income Q1, the aOR for remaining in income Q1 was 1.05 (95% CI 1.01-1.08) following a livebirth affected by severe neonatal morbidity, 1.29 (95% CI 1.12-1.48) after a neonatal death, and 1.35 (95% CI 1.24-1.46) after a stillbirth – each compared to mothers with an unaffected birth.

Conclusions — Mothers with a newborn affected by severe morbidity were more likely to have a decline in neighbourhood income Q, or to persist in the lowest-income area. Those experiencing stillbirth or neonatal death were more likely to remain in a lowest-income neighbourhood or have no income mobility.