title: Low socioeconomic status is a risk factor for preeclampsia: the Generation R Study.
abstract: OBJECTIVE
  To examine whether maternal socioeconomic status, as indicated by maternal educational level, is associated with preeclampsia, and if so, to what extent known risk factors for preeclampsia mediate the effect of educational level.
  
  
  METHODS
  In the Generation R Study, a population-based cohort study, we examined data of 3547 pregnant women. Odds ratios of preeclampsia for low, mid-low and mid-high educational level compared with high educational level were calculated after adjustment for confounders and additional adjustment for a selection of potential mediators (family history, material factors, psychosocial factors, substance use, working conditions, preexisting medical conditions, maternal anthropometrics and blood pressure at enrollment) that individually caused more than 10% change in the odds ratio for low education.
  
  
  RESULTS
  Adjusted for the confounding effects of age, gravidity and multiple pregnancy, women with low educational level were more likely to develop preeclampsia (odds ratio 5.12; 95% confidence interval: 2.20, 11.93) than women with high educational level. After additional adjustment for financial difficulties, smoking in pregnancy, working conditions, body mass index and blood pressure at enrollment, the odds ratio was 4.91 (95% confidence interval: 1.93, 12.52).
  
  
  CONCLUSIONS
  Low maternal socioeconomic status is a strong risk factor for preeclampsia. Only a small part of this association can be explained by the mediating effects of established risk factors for preeclampsia. Further research is needed to disentangle the pathway from low socioeconomic status to preeclampsia.
authors.affiliation: The Generation R Study Group, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, the Netherlands. l.silva@erasmusmc.nl
authors.forename: Lindsay M
authors.initials: LM
authors.lastname: Silva
authors.forename: Marianne
authors.initials: M
authors.lastname: Coolman
authors.forename: Eric Ap
authors.initials: EA
authors.lastname: Steegers
authors.forename: Vincent Wv
authors.initials: VW
authors.lastname: Jaddoe
authors.forename: Henriëtte A
authors.initials: HA
authors.lastname: Moll
authors.forename: Albert
authors.initials: A
authors.lastname: Hofman
authors.forename: Johan P
authors.initials: JP
authors.lastname: Mackenbach
authors.forename: Hein
authors.initials: H
authors.lastname: Raat
mesh_terms: D000328:Adult; D000886:Anthropometry; D001794:Blood Pressure; D005190:Family; D005260:Female; D006304:Health Status; D006801:Humans; D016015:Logistic Models; D009426:Netherlands / Q000453:epidemiology; D011225:Pre-Eclampsia / Q000453:epidemiology*; D011247:Pregnancy; D011446:Prospective Studies; D012307:Risk Factors; D012907:Smoking / Q000009:adverse effects; D012959:Socioeconomic Factors; D017132:Workplace