The aim of this study is to explore the association between grandparental socioeconomic disadvantages and grandchild psychiatric disorders, the role of parental socioeconomic and psychosocial factors in this association, as well as potential gender differences. We utilized a cohort study design using data from the Stockholm Birth Cohort Multigenerational Study, including 11,299 individuals born in 1953 (parental generation), their 22,598 parents (grandparental generation), and 24,707 adult children (grandchild generation). Grandparental and parental socioeconomic disadvantages, respectively, included low income, non-employment, and overcrowding. Parental psychosocial disadvantages included single parenthood, psychiatric disorders, and criminality. Psychiatric disorders in the grandchildren were reflected by hospitalizations due to mental and behavioral disorders from age 18 to 30 (1986–2019). Analyses were performed within the Structural Equation Modeling framework. We found an association between grandparental socioeconomic disadvantages and grandchild psychiatric disorders (standardized total effect 0.155, 95% confidence interval [CI] 0.099–0.211), which was mediated through parental psychosocial disadvantages (standardized mediating effect 0.101, 95% CI 0.073–0.130). The mediation was more pronounced via psychosocial disadvantages among mothers than fathers. These findings indicate that psychosocial disadvantages among parents, especially mothers, reflect an important mediating mechanism, and addressing such disadvantages may help mitigate social inequalities in mental health across generations.

BACKGROUND: Women with intellectual disabilities face significant barriers to gynecological, reproductive, antenatal, and perinatal care, which may adversely impact maternal and fetal health. Previous research indicates increased risks for gestational diabetes, pre-eclampsia, caesarean birth, preterm birth, and other complications in pregnant women with intellectual disabilities. However, studies on the reproductive health in this group remain scant, and comprehensive research on maternal and fetal health from pregnancy to the postpartum period remain missing.

OBJECTIVE(S): Using high-quality data from Swedish registers, the present study aims to examine a full range of maternal and fetal outcomes among birthing women with intellectual disabilities and to compare them to those of birthing women in the general population. Such knowledge is important in understanding and preventing adverse health outcomes.

STUDY DESIGN: This was a register study based on all women living in Skåne, Sweden on January 1^st, 2104, with at least 1 singleton birth in 2014–2021. By linking regional and national registers, we were able to compare maternal and fetal outcomes in a cohort of women with intellectual disabilities (n=378), including a subgroup of women with diagnosis of mild intellectual disability (n=177), to outcomes among women from the general population (n=65 925). Diagnoses (i.e., outcomes) were collected from the Skåne Healthcare Register, which comprises all healthcare contacts in the Skåne region in Sweden. Poisson regression was used to estimate relative risks (RRs) with 95% confidence intervals (CIs) to quantify the association between intellectual disability and each outcome. The fully adjusted model included maternal year of birth and age at birthing, sociodemographic indicators, and obstetric comorbidities.

RESULTS: In the fully adjusted models, women with intellectual disabilities had increased risk of pre-eclampsia (RR 1.67, 95% CI 1.15–2.42), infections of the genitourinary tract (2.30, 1.67–3.16), premature rupture of membranes (2.42, 1.24–4.69 for women with mild intellectual disability), and false labor (1.27, 1.05–1.53). In crude (i.e., unadjusted) models, increased risks were also found for maternal care for known or suspected fetal abnormality and damage, maternal care for other known or suspected fetal problems, other disorders of amniotic fluid and membranes, antepartum hemorrhage, not elsewhere classified, and failed induction of labor.

CONCLUSION(S): Pregnant women with intellectual disabilities have increased risk of several adverse maternal outcomes, with the risk for some likely driven-at least in part-by lower sociodemographic status and worse obstetric health.

Previous research has begun to unravel the mechanisms by which multiple factors in the parental generation link grandparental socioeconomic disadvantages to grandchild psychiatric disorders. This study aims to further disentangle such multigenerational mechanisms by exploring the role of parental childhood factors. We utilized a three-generational cohort study design with data from the Stockholm Birth Cohort Multigenerational Study. The sample included 2,708 individuals born in 1953 (parental generation, G1), their 5,416 parents (grandparental generation, G0), and 5,967 children (grandchild generation, G2). Using structural equation modeling (SEM), we analyzed the mediating role of G1 protective factors during childhood (i.e., high family relationship quality, positive parenting styles, high educational performance, positive peer relationships) and G1 adult psychosocial disadvantages (i.e., single parenthood, psychiatric disorders, and criminality) in the association between G0 socioeconomic disadvantages (i.e., low income, non-employment, and overcrowding) and G2 psychiatric disorders (i.e., measured as hospitalizations due to mental and behavioral disorders between ages 18 and 30). The association between G0 socioeconomic disadvantages and G2 psychiatric disorders was mediated through the paths from G1 childhood family relationship quality, peer relationships, and educational performance to G1 adult psychosocial disadvantages. Peer relationships and educational performance in childhood mattered more among G1 fathers, whereas family relationship quality in childhood played a more important role among G1 mothers. The findings indicate that parental childhood factors – specifically family relationship quality, peer relationships, and educational performance – serve as important resilience resources in disrupting the multigenerational transmission of disadvantages, with implications for mental health of future generations.

Childhood emotional and behavioral difficulties have a profound impact on later life outcomes, making it crucial to identify early-life risk factors that predict emotional and behavioral difficulties. However, much of the existing research has concentrated on diagnosing, rather than predicting, emotional and behavioral difficulties, and has often focused on adolescents rather than younger children. This study employs machine learning (ML) techniques to construct an interpretable predictive model using data from the UK Household Longitudinal Study, aiming to identify key risk factors that influence children's emotional and behavioral difficulties during childhood. We examined maternal habits during pregnancy and parent-reported data on birth, breastfeeding and regulatory problems during the newborn stage. Our findings highlighted lack of breastfeeding, low birthweight and maternal smoking during pregnancy as the three most significant predictors of emotional behavioral difficulties. Other important factors were related to infant regulatory problems. Heterogeneity analysis revealed gender differences in predictive power, with maternal smoking during pregnancy being a stronger predictor for boys, and the amount of fussing in infancy having a greater impact on girls. This study highlights the importance of comprehensive prenatal and postnatal care, advocates for early screening of emotional and behavioral difficulties, and calls for gender-specific approaches in assessing and addressing emotional and behavioral difficulties in children.

Purpose There is a lack of multigenerational research on the extent to which mental health is informed by transmission of multiple disadvantages across previous generations. This study aims to investigate how family socioeconomic and psychosocial disadvantages cluster and transition over grandparental and parental generations, and how this might be associated with grandchild psychiatric disorders.

Methods We utilized a cohort study with data following three generations from the Stockholm Birth Cohort Multigenerational Study, including 11,299 individuals born in 1953 (parental generation), their 22,598 parents (grandparental generation), and 24,707 adult children (grandchild generation). Family disadvantages as exposures were measured across two periods– grandparental adulthood (parental childhood) and parental adulthood (grandchild childhood), and included socioeconomic (i.e., low income, non-employment, overcrowding, and single parenthood) and psychosocial aspects (i.e., single parenthood, teenage motherhood, psychiatric disorders, and criminality of father). Psychiatric disorders in the adult grandchildren as outcome were defined by hospitalizations with a main or contributing diagnosis reflecting mental and behavioral disorders from age 18 until 2019.

Results Multiple disadvantages within the grandparental and parental generations, respectively, predicted higher probabilities of grandchild psychiatric disorders. Multigenerational transmission is evident in that grandchildren with combinations of grandparental socioeconomic disadvantages and parental psychosocial disadvantages had comparably high probabilities of psychiatric disorders. Importantly, improved socioeconomic and psychosocial circumstances across previous generations predicted comparably low probabilities of grandchild psychiatric disorders.

Conclusion Mental health of future generations is informed by the transmission of multiple disadvantages across previous generations, and the transition from grandparental socioeconomic disadvantages into parental psychosocial disadvantages is particularly important.

Introduction: Postpartum hemorrhage (PPH) is a key concern in maternal health, with early identification important for preventing severe complications. In a crowded delivery ward, where the number of births exceeds the normal range, labor management, and PPH prevention may be compromised. Although previous research has mainly focused on crowding over the entire day, it remains unclear whether crowding in the hours surrounding birth influences PPH risk. Therefore, our study aimed to assess the association between delivery ward crowding, adjacent to birth, and PPH and to explore whether births during periods of potentially lower staffing, such as summer months or weekends, could amplify this risk. Material and methods: This case-control study included 1 027 620 births in Sweden (2004–2019) from the Medical Birth Register. PPH, defined as estimated blood loss >1000 mL, cases were identified using a diagnostic code for PPH and were matched (1:10) with controls by the standardization criteria: delivery ward, year, and time of birth (night/day). The secondary outcome was PPH with blood transfusion. After standardization, crowding was defined as the number of births in a ±2-h interval around the index birth exceeding the 75th percentile. Unadjusted conditional logistic regression was used to study the association between crowding and PPH, PPH with blood transfusion, and to examine whether giving birth during a weekend or summer vacation month (June–August) modified these associations. Results were presented as odds ratios (OR) with 95% confidence intervals (CI). Results: Labor induction and emergency cesarean delivery were less common in births that occurred during crowded compared to noncrowded time intervals. Crowding was not associated with an increased risk of PPH (OR: 0.97; 95% CI: 0.95–0.99) or PPH with blood transfusion (OR: 0.99; 95% CI: 0.92–1.07). Giving birth during a summer month or a weekend did not change the estimates for the association between crowding and PPH. Conclusions: Focusing on a narrow time frame around birth, crowding in the delivery ward was not associated with an increased, but instead a modest reduction, in risk of PPH. Future studies should investigate how staffing in relation to crowding influences the risk of PPH and other adverse birth outcomes.

Background While well-established associations exist between socioeconomic conditions and smoking during pregnancy (SDP), less is known about social disparities in the risk of continuous SDP. Intersectional analyses that consider multiple social factors simultaneously can offer valuable insight for planning smoking cessation interventions.

Methods We include all 146,222 pregnancies in Sweden between 2006 and 2016 where the mother smoked at three months before pregnancy. The outcome was continuous SDP defined as self-reported smoking in the third trimester. Exposures were age, education, migration status and civil status. We examined all exposures in a mutually adjusted unidimensional analysis and in an intersectional model including 36 possible combinations. We present ORs with 95% Confidence Intervals, and the Area Under the Curve (AUC) as a measure of discriminatory accuracy (DA).

Results In our study, education status was the factor most strongly associated to continuous SDP among women who smoked at three months before pregnancy. In the unidimensional analysis women with low and middle education had ORs for continuous SDP of 6.92 (95%CI 6.63–7.22) and 3.06 (95%CI 2.94–3.18) respectively compared to women with high education. In the intersectional analysis, odds of continuous SDP were 17.50 (95%CI 14.56–21.03) for married women born in Sweden aged ≥ 35 years with low education, compared to the reference group of married women born in Sweden aged 25–34 with high education. AUC-values were 0.658 and 0.660 for the unidimensional and intersectional models, respectively.

Conclusion The unidimensional and intersectional analyses showed that low education status increases odds of continuous SDP but that in isolation education status is insufficient to identify the women at highest odds of continuous SDP. Interventions targeted to social groups should be preceded by intersectional analyses but further research is needed before recommending intensified smoking cessation to specific social groups.

Background: Well-established associations exist between the risk of small for gestational age (SGA) and unidimensional sociodemographic factors. We investigated social inequalities in SGA risk and adopted an intersectional approach that simultaneously considers different social categories. By doing so, we could assess heterogeneities in SGA risk within unidimensional sociodemographic categories.

Methods: We included all live 679 694 singleton births in Sweden between 2010 and 2016. The outcome was SGA, and the exposures were age, maternal educational level, dichotomous migration status and civil status. Thirty-six possible combinations of these factors constituted the exposure in an intersectional model. We present odds ratios (ORs) with 95% confidence intervals (95% CIs) and the area under the receiver operating characteristic curve (AUC)—a measurement of discriminatory accuracy (i.e. the ability to discriminate the babies born SGA from those who are not).

Results: Women with low education and women born outside Sweden had ORs of 1.46 (95% CI 1.38–1.54) and 1.50 (95% CI 1.43–1.56) in unidimensional analyses, respectively. Among women aged under 25 with low education who were born outside Sweden and unmarried, the highest OR was 3.06 (2.59–3.63). The discriminatory accuracy was low for both the unidimensional model that included all sociodemographic factors (AUC 0. 563) and the intersectional model (AUC 0.571).

Conclusions: The intersectional approach revealed a complex sociodemographic pattern of SGA risk. Sociodemographic factors have a low accuracy in identifying SGA at the individual level, even when quantifying their multi-dimensional intersections. This cautions against interventions targeted to individuals belonging to socially defined groups to reduce social inequalities in SGA risk.

Families involved with child welfare services (CWS) often diverge systematically from the general population. They are more likely to live in challenging circumstances characterised by adverse socioeconomic conditions (e.g. poverty) and psychosocial adversities (e.g. mental health problems and substance misuse). Past research has primarily focused on the development and lifelong health and social outcomes of children who have experienced out-of-home care (OHC). However, the separation could also trigger negative emotions and other changes in parents, but much less attention has been paid to the associations between children’s placement and parents’ lives.

This scoping review synthesises results from quantitative studies investigating the socioeconomic and psychosocial outcomes of parents who have experienced the removal of a child into OHC. Six databases were comprehensively searched, with 15 studies selected for inclusion in the review. Studies were conducted among countries of the Organization for Economic Cooperation and Development (OECD) with substantial heterogeneity in the methods and designs, as grouped into three categories: “cross-sectional assessments” (4 studies), “longitudinal assessments” (7 studies) and “pre-post assessment” (4 studies).

To a large extent, studies focus on psychosocial outcomes among mothers. The majority indicate that having a child placed in OHC is associated with the deterioration of psychosocial or socioeconomic outcomes among parents. We may conclude that parents who have experienced the removal of a child are a group that deserves tailored support and counselling. However, further quantitative research into aspects of parents’ lives after children’s OHC placement is needed, particularly with longitudinal designs and more rigorous methods to enable a better understanding of the causes and effects of these associations. This might support the development of targeted and effective interventions for these families.