title: Preterm birth and social inequality: assessing the effects of material and psychosocial disadvantage in a UK birth cohort.
abstract: OBJECTIVE
  To examine the association between social inequalities and preterm birth, testing both psychosocial and material determinants.
  
  
  METHODS
  Retrospective cohort study with linked hospital data.
  
  
  METHODS
  17 285 women in England, Scotland, Northern Ireland and Wales giving birth to singletons included in wave 1 of the UK Millennium Cohort Study.
  
  
  METHODS
  Social inequalities were measured with material (household income, housing tenure) and psychosocial (education, occupational class, employment, social support) indicators. Analysis using multivariable logistic regression assessed odds of preterm birth, adjusting for demographics, health and health-related behaviors, pregnancy and delivery conditions, and pregnancy complications.
  
  
  METHODS
  Preterm birth between 24 and 36 weeks, 6 days' gestation.
  
  
  RESULTS
  Initial bivariable analysis suggested associations between preterm birth and household income, housing tenure, and education. These effects were largely explained by adjustment for other social determinants in multivariable models. Following full adjustment, effects of unemployment [OR = 1.52, 95% confidence interval (CI) 1.21-1.90, p < 0.001] and one indicator of poor social support (OR = 1.17, 95% CI 1.01-1.35, p = 0.04) remained significant.
  
  
  CONCLUSIONS
  Unemployment and lack of social support are associated with higher risk of preterm birth, supporting the hypothesis that poor psychosocial circumstances elevate a woman's risk of this adverse perinatal outcome. Further research is needed to examine the causal pathways through which social inequalities affect preterm birth.
authors.affiliation: Department of Obstetrics and Gynecology, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.
authors.forename: John W
authors.initials: JW
authors.lastname: Snelgrove
authors.affiliation: Department of Obstetrics and Gynecology, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.|Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Mt. Sinai Hospital, Toronto, Ontario, Canada.
authors.forename: Kellie E
authors.initials: KE
authors.lastname: Murphy
mesh_terms: D000328:Adult; D015331:Cohort Studies; D005260:Female; D006801:Humans; D011247:Pregnancy; D047928:Premature Birth / Q000453:epidemiology*; D012189:Retrospective Studies; D012923:Social Class; D012944:Social Support; D014478:Unemployment; D006113:United Kingdom / Q000453:epidemiology
keywords: Millennium Cohort Study; Preterm birth; United Kingdom; epidemiology; social class; social determinants of health; social support