Born Unequal: Maternal Socioeconomic Factors and Adherence to Best Practices in Early Childhood

Abstract Introduction The first 1,000 days of life offers a unique opportunity for child development. Understanding social inequalities during this period is essential for addressing programs with an equity-based approach. Objectives To assess the association between maternal socioeconomic characteristics and adherence to the best practices monitored by the Italian Surveillance System for Children aged 0-2 years coordinated by Italian National Institute of Health. Methods Data were collected through a self-administered multilingual questionnaire distributed at vaccination centres, ensuring regional and local representativeness. Topics include folic acid supplementation, alcohol and tobacco use during pregnancy and lactation, breastfeeding, infant sleep position, family reading, screen exposure, home and transport safety, and vaccination intentions. Multivariate Poisson regressions were used to assess associations between maternal characteristics (educational level, citizenship, and perceived economic status) and adherence to best practices. Results In 2022, 35,550 mothers participated (95% response rate). Higher maternal education was associated with greater adherence to most recommended practices, including folic acid use, breastfeeding, smoking avoidance, sleep position, limiting screen exposure, and promoting family reading. Mothers with lower education level reported lower alcohol consumption during pregnancy and lactation. Italian mothers generally adhered more closely to best practices than foreigners, although they were more likely to smoke during pregnancy and less likely to exclusively breastfeed at 4-5 months. Mothers reporting financial hardship were less likely to follow recommendations. Conclusions We found a relevant impact of maternal socioeconomic inequalities on adherence to best practices. Public health strategies targeting the first 1,000 days of life must be tailored to address these disparities and support families facing greater social challenges. Key messages • The Italian Surveillance is a key tool for guiding family services with an equity-oriented approach. • Early health promotion plays a key role in reducing inequalities and supporting lifelong health.