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Explaining educational inequalities in preterm birth: the generation r study
  1. P W Jansen1,2,3,
  2. H Tiemeier3,4,
  3. V W V Jaddoe1,4,5,
  4. A Hofman4,
  5. E A P Steegers6,
  6. F C Verhulst3,
  7. J P Mackenbach2,
  8. H Raat2
  1. 1
    The Generation R Study Group, Erasmus MC-University Medical Center Rotterdam, Rotterdam, The Netherlands
  2. 2
    Department of Public Health, Erasmus MC-University Medical Center Rotterdam, Rotterdam, The Netherlands
  3. 3
    Department of Child and Adolescent Psychiatry, Erasmus MC-University Medical Center Rotterdam, Rotterdam, The Netherlands
  4. 4
    Department of Epidemiology & Biostatistics, Erasmus MC-University Medical Center Rotterdam, Rotterdam, The Netherlands
  5. 5
    Department of Paediatrics, Erasmus MC-University Medical Center Rotterdam, Rotterdam, The Netherlands
  6. 6
    Department of Obstetrics and Gynaecology, Erasmus MC-University Medical Center Rotterdam, Rotterdam, The Netherlands
  1. P W Jansen, The Generation R Study Group, Erasmus MC-University Medical Center Rotterdam, PO Box 2040 (Room Ae-029), 3000 CA Rotterdam, The Netherlands; p.w.jansen{at}erasmusmc.nl

Abstract

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.

Aim: 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.

Findings: 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.

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Footnotes

  • None.

    The Medical Ethical Committee of the Erasmus Medical Center, Rotterdam, has approved the study.

    Written informed consent was obtained from all participants.

  • The present study was supported by an additional grant from the Netherlands Organization for Health Research and Development (ZonMW “Geestkracht” program 10.000.1003).

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