Explaining educational inequalities in preterm birth: the generation r study.
BACKGROUND
Although a low socioeconomic status has consistently been associated with an increased risk of preterm birth, little is known about the pathways through which socioeconomic disadvantage influences preterm birth.


OBJECTIVE
To examine mechanisms that might underlie the association between the educational level of pregnant women as an indicator of socioeconomic status, and preterm birth.


METHODS
The study was nested in a population-based cohort study in the Netherlands. Information was available for 3830 pregnant women of Dutch origin.


RESULTS
The lowest-educated pregnant women had a statistically significant higher risk of preterm birth (odds ratio (OR) = 1.89 (95% CI 1.28 to 2.80)) than the highest educated women. This increased OR was reduced by up to 22% after separate adjustment for age, height, preeclampsia, intrauterine growth restriction, financial concerns, long-lasting difficulties, psychopathology, smoking habits, alcohol consumption, and body mass index (BMI) of the pregnant women. Joint adjustment for these variables resulted in a reduction of 89% of the increased risk of preterm birth among low-educated pregnant women (fully adjusted OR = 1.10 (95% CI 0.66 to 1.84)).


CONCLUSIONS
Pregnant women with a low educational level have a nearly twofold higher risk of preterm birth than women with a high educational level. This elevated risk could largely be explained by pregnancy characteristics, indicators of psychosocial well-being, and lifestyle habits. Apparently, educational inequalities in preterm birth go together with an accumulation of multiple adverse circumstances among women with a low education. A number of explanatory mechanisms unravelled in the present study seem to be modifiable by intervention programmes.
The Generation R Study Group, Erasmus MC-University Medical Center Rotterdam, Rotterdam, The Netherlands. p.w.jansen@erasmusmc.nl
P W
PW
Jansen
H
H
Tiemeier
V W V
VW
Jaddoe
A
A
Hofman
E A P
EA
Steegers
F C
FC
Verhulst
J P
JP
Mackenbach
H
H
Raat
D000328:Adult; D000428:Alcohol Drinking / Q000009:adverse effects* / Q000517:prevention & control; D004522:Educational Status; D004812:Epidemiologic Methods; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D008297:Male; D009426:Netherlands / Q000453:epidemiology; D011225:Pre-Eclampsia / Q000139:chemically induced* / Q000517:prevention & control; D011247:Pregnancy; D047928:Premature Birth / Q000453:epidemiology / Q000209:etiology* / Q000517:prevention & control; D012907:Smoking / Q000009:adverse effects*; D000074606:Smoking Prevention