The social gradient in birthweight at term: quantification of the mediating role of maternal smoking and body mass index.
BACKGROUND
Maternal education is associated with the birthweight of offspring. We sought to quantify the role of maternal body mass index (BMI) and smoking as intermediary variables between maternal education and birthweight at term.


METHODS
We examined the association between maternal education, BMI, smoking and offspring's birthweight among women who delivered at term in the Danish National Birth Cohort (n = 75,085).


RESULTS
Compared with mothers with more than 12 years of education, women with 10-12 years of education had babies that were 12 (4-19) g lighter. Mothers with 9 years of education had babies that were 51 (95% CI; 39-62) g lighter. BMI and smoking affected the association between maternal education and birthweight, albeit in different directions. If all mothers had the BMI of the highest educated mothers, the deficits would be larger: -20 (-22 to -19) and -74 (-80 to -68) g, respectively. If all mothers smoked like the highest educated mothers, mothers with a shorter education would have the heaviest babies: the difference would be 9 (2-16) and 23 (11-36) g, respectively. In combination, smoking and BMI all but explained the educational gradient in birthweight at term.


CONCLUSIONS
Maternal smoking and BMI are important intermediates of the educational gradient in birthweight at term. As the prevalence of smoking is dropping and the prevalence of obesity is increasing the educational gradient will likely reverse, but it seems unlikely that this will translate into a health advantage for the children of the least educated mothers.
Mortensen
Laust H
LH
National Institute of Public Health, University of Southern Denmark, Øster Farimagsgade 5A, 2nd floor, 1399 Copenhagen K, Denmark. laust.mortensen@gmail.com
Diderichsen
Finn
F
Smith
George Davey
GD
Andersen
Anne Marie Nybo
AM
D000328:Adult; D001724:Birth Weight; D015992:Body Mass Index; D015331:Cohort Studies; D004522:Educational Status; D005260:Female; D005865:Gestational Age; D006801:Humans; D018811:Maternal Exposure; D011247:Pregnancy; D012907:Smoking; D012959:Socioeconomic Factors