Mother's education and the risk of preterm and small for gestational age birth: a DRIVERS meta-analysis of 12 European cohorts.
BACKGROUND
A healthy start to life is a major priority in efforts to reduce health inequalities across Europe, with important implications for the health of future generations. There is limited combined evidence on inequalities in health among newborns across a range of European countries.


METHODS
Prospective cohort data of 75 296 newborns from 12 European countries were used. Maternal education, preterm and small for gestational age births were determined at baseline along with covariate data. Regression models were estimated within each cohort and meta-analyses were conducted to compare and measure heterogeneity between cohorts.


RESULTS
Mother's education was linked to an appreciable risk of preterm and small for gestational age (SGA) births across 12 European countries. The excess risk of preterm births associated with low maternal education was 1.48 (1.29 to 1.69) and 1.84 (0.99 to 2.69) in relative and absolute terms (Relative/Slope Index of Inequality, RII/SII) for all cohorts combined. Similar effects were found for SGA births, but absolute inequalities were greater, with an SII score of 3.64 (1.74 to 5.54). Inequalities at birth were strong in the Netherlands, the UK, Sweden and Spain and marginal in other countries studied.


CONCLUSIONS
This study highlights the value of comparative cohort analysis to better understand the relationship between maternal education and markers of fetal growth in different settings across Europe.
Research Department of Epidemiology and Public Health, University College London, London, UK.
Milagros
M
Ruiz
Research Department of Epidemiology and Public Health, UCL Institute of Health Equity, University College London, London, UK.
Peter
P
Goldblatt
Research Department of Epidemiology and Public Health, University College London, London, UK.
Joana
J
Morrison
Faculty of Science, Research Centre for Toxic Compounds in the Environment (RECETOX), Masaryk University, Brno, Czech Republic.
Lubomír
L
Kukla
Faculty of Science, Research Centre for Toxic Compounds in the Environment (RECETOX), Masaryk University, Brno, Czech Republic Faculty of Medicine, Institute of Biostatistics and Analyses, Masaryk University, Brno, Czech Republic.
Jan
J
Švancara
Department of Epidemiology and Biostatistics, MRC Health Protection Agency (HPE), Centre for Environment and Health, School of Public Health, Imperial College London, London, UK Unit of Primary Care, Oulu University Hospital, Oulu, Finland Center for Life Course Epidemiology, Faculty of Medicine, University of Oulu, Oulu, Finland Institute of Health Sciences, University of Oulu, Oulu, Finland.
Marjo
M
Riitta-Järvelin
Biocenter Oulu, University of Oulu, Oulu, Finland.
Anja
A
Taanila
Institut National de la Santé et de la Recherche Médicale (INSERM) UMR 1153, Obstetrical, Perinatal and Pediatric Epidemiology Research Team (Epopé), Center for Epidemiology and Statistics, Sorbonne Paris Cité, DHU Risks in Pregnancy, Paris Descartes University, Paris, France.
Marie-Josèphe
MJ
Saurel-Cubizolles
Institut National de la Santé et de la Recherche Médicale (INSERM) UMR 1153, Early Origin of the Child's Health and Development Team (ORCHAD), Center for Epidemiology and Statistics, Sorbonne Paris Cité, Paris Descartes University, Paris, France.
Sandrine
S
Lioret
First Department of Paediatrics, University of Athens, Aghia Sophia Children's Hospital, Athens, Greece.
Chryssa
C
Bakoula
First Department of Paediatrics, University of Athens, Aghia Sophia Children's Hospital, Athens, Greece.
Alexandra
A
Veltsista
Department of Epidemiology of the Lazio Regional Health System, Rome, Italy.
Daniela
D
Porta
Department of Epidemiology of the Lazio Regional Health System, Rome, Italy.
Francesco
F
Forastiere
Department of Epidemiology and Health Promotion, Public Health Service of Amsterdam, Amsterdam, The Netherlands.
Manon
M
van Eijsden
Department of Public Health, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.
Tanja G M
TG
Vrijkotte
Department of Genes and Environment, Norwegian Institute of Public Health, Oslo, Norway.
Merete
M
Eggesbø
Department of Genes and Environment, Norwegian Institute of Public Health, Oslo, Norway.
Richard A
RA
White
Department of Clinical Epidemiology, Predictive Medicine and Public Health, University of Porto Medical School, Porto, Portugal EPIUnit - Institute of Public Health, University of Porto, Porto, Portugal.
Henrique
H
Barros
Department of Clinical Epidemiology, Predictive Medicine and Public Health, University of Porto Medical School, Porto, Portugal EPIUnit - Institute of Public Health, University of Porto, Porto, Portugal.
Sofia
S
Correia
Center for Research in Environmental Epidemiology (CREAL), Barcelona, Spain Spanish Consortium for Research on Epidemiology and Public Health (CIBERESP), Barcelona, Spain.
Martine
M
Vrijheid
Spanish Consortium for Research on Epidemiology and Public Health (CIBERESP), Barcelona, Spain IB-Salut Menorca Health Area, Balearic Islands, Spain.
Maties
M
Torrent
Spanish Consortium for Research on Epidemiology and Public Health (CIBERESP), Barcelona, Spain Departamento de Medicina, Universitat Jaume I, Castellon, Spain.
Marisa
M
Rebagliato
Public Health Department of Gipuzkoa, Gipuzkoa, Spain BIODONOSTIA Health Research Institute, San Sebastian, Spain.
Isabel
I
Larrañaga
Division of Pediatrics, Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden.
Johnny
J
Ludvigsson
Department of Medicine and Health Sciences, Linköping University, Linköping, Sweden.
Åshild
Å
Olsen Faresjö
Center for Global Health, University of Illinois College of Medicine, Chicago, Illinois, USA.
Daniel
D
Hryhorczuk
Institute of Pediatrics, Obstetrics, and Gynecology, Kyiv, Ukraine.
Youriy
Y
Antipkin
Research Department of Epidemiology and Public Health, University College London, London, UK Research Department of Epidemiology and Public Health, UCL Institute of Health Equity, University College London, London, UK.
Michael
M
Marmot
Research Department of Epidemiology and Public Health, University College London, London, UK.
Hynek
H
Pikhart
D003431:Cross-Cultural Comparison; D004522:Educational Status; D005060:Europe / Q000453:epidemiology; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D007236:Infant, Small for Gestational Age; D016014:Linear Models; D008297:Male; D009035:Mothers / Q000706:statistics & numerical data*; D011247:Pregnancy; D011256:Pregnancy Outcome / Q000453:epidemiology*; D047928:Premature Birth / Q000453:epidemiology*; D011446:Prospective Studies; D012044:Regression Analysis; D012307:Risk Factors
CHILD HEALTH; EPIDEMIOLOGY; INEQUALITIES