• Elie Kantor, Jean Guglielminotti, Elie Azria, Dominique Luton, Mandelbrot Laurent, Jean-François Oury, Dominique Mahieu-Caputo, Philippe Ravaud, Candice Estellat, and PreCARE Study Group.
• From the *Institut National de la Santé et de la Recherche Médicale (INSERM), Centre d'Investigation Clinique (CIC) 1425-Epidémiologie Clinique (EC), UMR 1123, Paris, France; ‡Département d'Anesthésie-Réanimation, Hôpital Bichat-Claude Bernard, Assistance Publique- Hôpitaux de Paris (AP-HP), Paris, France; §INSERM, Unité Mixte de Recherche 1137, Infection, Antimicrobiens, Modélisation, Evolution, Paris, France; ‖INSERM, UMR 1153, Équipe de Recherche en épidémiologie Obstétricale Périnatale et Pédiatrique, Université Paris Descartes, Paris, France; ¶Maternité Notre Dame de Bon Secours, Groupe Hospitalier Paris Saint Joseph, Paris, France; #Service de Gynécologie-Obstétrique, Hôpital Beaujon, AP-HP, Clichy, France; **Service de Gynécologie-Obstétrique, Hôpital Louis Mourier, AP-HP, Colombes, France; ††Service de Gynécologie-Obstétrique, Hôpital Robert Debré, AP-HP, Paris, France; ‡‡Service de Gynécologie-Obstétrique, Hôpital Bichat, AP-HP, Paris, France; §§Centre d'Epidémiologie Clinique, Hôpital Hôtel-Dieu, AP-HP, Paris, France; ‖‖Pôle de Recherche et d'Enseignement Supérieur Sorbonne Paris Cité, Université Paris Descartes, Paris, France; ¶¶Centre de Pharmaco-épidémiologie de l'AP-HP, Unité de Recherche Clinique des Hôpitaux Universitaires Pitié Salpêtrière - Charles Foix, Hôpitaux Universitaires Pitié Salpêtrière - Charles Foix, AP-HP, Paris France; and ##INSERM, UMR 1123 Epidémiologie Clinique et évaluation économique Appliquées aux Populations Vulnérables, Paris, France.
• Anesth. Analg. 2017 Sep 1; 125 (3): 925-933.

BackgroundSocioeconomic deprivation is associated with reduced use of antenatal resources and poor maternal outcomes with pregnancy. Research examining the association between socioeconomic deprivation and use of obstetric anesthesia care in a country providing universal health coverage is scarce. We hypothesized that in a country providing universal health coverage, France, socioeconomic deprivation is not associated with reduced use of anesthetic care during pregnancy and delivery. This study aimed to examine the association between socioeconomic deprivation and (1) completion of a mandatory preanesthetic evaluation during pregnancy and (2) use of neuraxial analgesia during labor.MethodsData were from a cohort of 10,419 women who delivered between 2010 and 2011 in 4 public teaching hospitals in Paris. We used a deprivation index that included 4 criteria: social isolation, poor housing condition, no work-related household income, and state-funded health care insurance. Socioeconomic deprivation was defined as a deprivation index greater than 1. Preanesthetic evaluation was considered completed if performed more than 48 hours before delivery. The association between socioeconomic deprivation and completion of the preanesthetic evaluation and use of neuraxial labor analgesia was assessed by multivariable logistic regression adjusting for education level, country of birth, and maternal and pregnancy characteristics.ResultsPreanesthetic evaluation was completed for 8142 of the 8624 women (94.4%) analyzed and neuraxial labor analgesia was used by 6258 of the 6834 women analyzed (91.6%). After adjustment, socioeconomic deprivation was associated with reduced probability of completed preanesthetic evaluation (adjusted odds ratio 0.88 [95% confidence interval, 0.79-0.98]; P = .027) but not use of neuraxial labor analgesia (adjusted odds ratio 0.97 [95% confidence interval, 0.87-1.07]; P = .540).ConclusionsIn a country providing universal health care coverage, women who were socioeconomically deprived showed reduced completion of preanesthetic evaluation during pregnancy but not reduced use of neuraxial labor analgesia. Interventions should be targeted to socioeconomically deprived women to increase the completion of the preanesthetic evaluation.

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