Farzaneh Abbasi, Mohsen Heidari, Farshad Sharifi, Reihaneh Mohsenipour, Rasta Moradi, Hadis Izadi, Azita Karimi, Saeideh Abdolahpour
Newborn bloodspot screening (NBS) is a critical public health intervention for the early detection of inherited metabolic disorders (IMDs). Despite high national coverage in Iran, substantial socioeconomic and migration-related disparities in NBS uptake persist in urban settings. This study aimed to identify socioeconomic, migration-related, and healthcare access determinants associated with reduced NBS uptake among parents in Tehran. A case-control study was conducted among 402 parents attending public health centers affiliated with Tehran University of Medical Sciences between January 1 to October 25, 2025. Cases (n = 108) were parents classified as having NBS non-uptake, and controls (n = 294) were parents in the NBS uptake group. Data were collected using a validated questionnaire and analyzed using univariate and multivariable logistic regression. Odds ratios (ORs) and 95% confidence intervals (CIs) were estimated, with ORs interpreted in relation to NBS uptake. Overall, 26.9% of parents did not complete NBS. In multivariable analyses, NBS non-uptake was significantly higher among non-Iranian families, households in lower income categories, and those lacking supplemental health insurance. Additional factors associated with non-uptake in univariable analyses included limited healthcare access and lower perceived importance of NBS (p < 0.05). Higher perceived importance of screening and physician-delivered prenatal education were strongly associated with greater NBS uptake. Reduced uptake of newborn metabolic screening in Tehran is associated primarily with economic vulnerability and structural barriers faced by migrant families. Equity-oriented interventions-including multilingual counseling, full cost waivers, integration of NBS education into prenatal care, and simplified registration pathways for migrant newborns-are essential to improve participation and strengthen the effectiveness of national screening programs.