PT  - JOURNAL ARTICLE
AU  - Jansen, P W
AU  - Tiemeier, H
AU  - Jaddoe, V W V
AU  - Hofman, A
AU  - Steegers, E A P
AU  - Verhulst, F C
AU  - Mackenbach, J P
AU  - Raat, H
TI  - Explaining educational inequalities in preterm birth: the generation r study
AID  - 10.1136/adc.2007.136945
DP  - 2009 Jan 01
TA  - Archives of Disease in Childhood - Fetal and Neonatal Edition
PG  - F28--F34
VI  - 94
IP  - 1
4099  - http://fn.bmj.com/content/94/1/F28.short
4100  - http://fn.bmj.com/content/94/1/F28.full
SO  - Arch Dis Child Fetal Neonatal Ed2009 Jan 01; 94
AB  - 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.