title: Socioeconomic factors and the risk of anencephaly in a Mexican population: a case-control study.
abstract: OBJECTIVE
  The study was designed to evaluate the association between socioeconomic level (as measured by maternal education, maternal occupation, and monthly family income) and anencephaly.
  
  
  METHODS
  The authors conducted a case-control study using data from the Epidemiological Surveillance System Register for Neural Tube Defects for three states of the Mexican Republic: Puebla, Guerrero and the State of Mexico. Mothers of 151 cases of infants born with anencephaly and mothers of 151 control infants born during the period March 2000 to February 2001 were interviewed about their socioeconomic characteristics and other factors including reproductive history, use of prenatal care, use of tobacco and alcohol, fever during pregnancy, and folic acid supplementation.
  
  
  RESULTS
  After adjustment for potential confounders, a risk gradient was seen with decreasing maternal education. Women with less than a primary school education (adjusted odds ratio [OR]=3.0; 95% confidence interval [CI] 1.2, 7.6) and women who had completed primary school but had not completed junior high school (adjusted OR=2.2; 95% CI 0.9, 5.7) had higher risks of giving birth to an infant with anencephaly, compared to women with a higher educational level. A monthly income < or = 1,000 pesos (approximately dollars 100 U.S.) was also associated with a higher risk of anencephaly (OR=2.5; 95% CI 1.2, 5.1). Women employed in industry or agriculture during the acute risk period (three months prior to conception to one month after conception) had a risk 6.5 times (95% CI 1.4, 29.6) that of professional and business women.
  
  
  CONCLUSIONS
  This study helps to identify groups that may be especially vulnerable to this type of congenital malformation so that primary and secondary preventive strategies can be targeted to these groups.
authors.affiliation: Instituto Nacional de Salud Pública (National Institute of Public Health), Cuernavaca, Morelos, Mexico.
authors.forename: Julia
authors.initials: J
authors.lastname: Blanco Muñoz
authors.forename: Marina
authors.initials: M
authors.lastname: Lacasaña
authors.forename: Victor Hugo
authors.initials: VH
authors.lastname: Borja Aburto
authors.forename: Luisa Elvira
authors.initials: LE
authors.lastname: Torres Sánchez
authors.forename: Ana María
authors.initials: AM
authors.lastname: García García
authors.forename: Lizbeth
authors.initials: L
authors.lastname: López Carrillo
mesh_terms: D000293:Adolescent; D000328:Adult; D000757:Anencephaly / Q000191:economics / Q000453:epidemiology* / Q000517:prevention & control; D016022:Case-Control Studies; D004493:Education; D004522:Educational Status; D005260:Female; D006801:Humans; D007182:Income; D007231:Infant, Newborn; D016555:Matched-Pair Analysis; D008800:Mexico / Q000453:epidemiology; D009035:Mothers / Q000193:education / Q000706:statistics & numerical data; D009790:Occupations; D012307:Risk Factors; D012959:Socioeconomic Factors
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