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Disparities in Pregnancy Outcomes According to Marital and Cohabitation Status

Zhong-Cheng Luo, PhD^*, Russell Wilkins, MURB and Michael S. Kramer, MD^* the Fetal and Infant Health Study Group of the Canadian Perinatal Surveillance System^*

From the Departments of Epidemiology and Biostatistics and of Pediatrics, McGill University, Montreal, Quebec, Canada; and Health Analysis and Measurement Group, Statistics Canada, Ottawa, Ontario, Canada.

Address reprint requests to: Michael S. Kramer, MD, 2300 Tupper Street, Room F-265, The Montreal Children’s Hospital, Montreal, Quebec, Canada H3H 1P3; e-mail: michael.kramer{at}mcgill.ca.

OBJECTIVE: To assess the risks and trends of adverse pregnancy outcomes among mothers in common-law unions versus traditional marriage relationships.

METHODS: We conducted a birth cohort-based study of all 720,586 births registered in Quebec for the years 1990 to 1997.

RESULTS: The proportion of births to common-law mothers more than doubled from 20% in 1990 to 44% in 1997. Preterm birth, low birth weight, small for gestational age, and neonatal and postneonatal mortality rates increased progressively from mothers legally married, to common-law unions, to lone mothers with father information, to lone mothers without father information on birth registrations. Adjusted odd ratios with 95% confidence intervals (CIs) for common-law versus legally married mothers were 1.14 (95% CI 1.11, 1.17) for preterm birth, 1.21 (95% CI 1.18, 1.25) for low birth weight, 1.18 (95% CI 1.16, 1.20) for small for gestational age, 1.07 (95% 0.97, 1.19) for neonatal death, and 1.23 (95% CI 1.04, 1.44) for postneonatal death after controlled for observed individual- and community-level characteristics. The crude and adjusted odds ratios were virtually unchanged over time.

CONCLUSION: Pregnancy outcomes are worse among mothers in common-law unions versus traditional marriage relationships but better than among mothers living alone. Modest disparities in pregnancy outcomes in common-law versus traditional marriage relationships have persisted despite the striking rise in common-law unions.

LEVEL OF EVIDENCE: II-2

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