TY - JOUR T1 - Explaining educational inequalities in preterm birth: the generation r study JF - Archives of Disease in Childhood - Fetal and Neonatal Edition JO - Arch Dis Child Fetal Neonatal Ed SP - F28 LP - F34 DO - 10.1136/adc.2007.136945 VL - 94 IS - 1 AU - P W Jansen AU - H Tiemeier AU - V W V Jaddoe AU - A Hofman AU - E A P Steegers AU - F C Verhulst AU - J P Mackenbach AU - H Raat Y1 - 2009/01/01 UR - http://fn.bmj.com/content/94/1/F28.abstract N2 - 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)β€Š=β€Š1.89 (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 ORβ€Š=β€Š1.10 (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. ER -