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Mother's education and the risk of preterm and small for gestational age birth: a DRIVERS meta-analysis of 12 European cohorts
  1. Milagros Ruiz1,
  2. Peter Goldblatt2,
  3. Joana Morrison1,
  4. Lubomír Kukla3,
  5. Jan Švancara3,4,
  6. Marjo Riitta-Järvelin5,7,8,9,
  7. Anja Taanila6,
  8. Marie-Josèphe Saurel-Cubizolles10,
  9. Sandrine Lioret11,
  10. Chryssa Bakoula12,
  11. Alexandra Veltsista12,
  12. Daniela Porta13,
  13. Francesco Forastiere13,
  14. Manon van Eijsden14,
  15. Tanja G M Vrijkotte15,
  16. Merete Eggesbø16,
  17. Richard A White16,
  18. Henrique Barros17,18,
  19. Sofia Correia17,18,
  20. Martine Vrijheid19,20,
  21. Maties Torrent20,21,
  22. Marisa Rebagliato20,22,
  23. Isabel Larrañaga23,24,
  24. Johnny Ludvigsson25,
  25. Åshild Olsen Faresjö26,
  26. Daniel Hryhorczuk27,
  27. Youriy Antipkin28,
  28. Michael Marmot1,2,
  29. Hynek Pikhart1
  1. 1Research Department of Epidemiology and Public Health, University College London, London, UK
  2. 2Research Department of Epidemiology and Public Health, UCL Institute of Health Equity, University College London, London, UK
  3. 3Faculty of Science, Research Centre for Toxic Compounds in the Environment (RECETOX), Masaryk University, Brno, Czech Republic
  4. 4Faculty of Medicine, Institute of Biostatistics and Analyses, Masaryk University, Brno, Czech Republic
  5. 5Department of Epidemiology and Biostatistics, MRC Health Protection Agency (HPE), Centre for Environment and Health, School of Public Health, Imperial College London, London, UK
  6. 6Biocenter Oulu, University of Oulu, Oulu, Finland
  7. 7Unit of Primary Care, Oulu University Hospital, Oulu, Finland
  8. 8Center for Life Course Epidemiology, Faculty of Medicine, University of Oulu, Oulu, Finland
  9. 9Institute of Health Sciences, University of Oulu, Oulu, Finland
  10. 10Institut 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
  11. 11Institut 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
  12. 12First Department of Paediatrics, University of Athens, Aghia Sophia Children's Hospital, Athens, Greece
  13. 13Department of Epidemiology of the Lazio Regional Health System, Rome, Italy
  14. 14Department of Epidemiology and Health Promotion, Public Health Service of Amsterdam, Amsterdam, The Netherlands
  15. 15Department of Public Health, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
  16. 16Department of Genes and Environment, Norwegian Institute of Public Health, Oslo, Norway
  17. 17Department of Clinical Epidemiology, Predictive Medicine and Public Health, University of Porto Medical School, Porto, Portugal
  18. 18EPIUnit – Institute of Public Health, University of Porto, Porto, Portugal
  19. 19Center for Research in Environmental Epidemiology (CREAL), Barcelona, Spain
  20. 20Spanish Consortium for Research on Epidemiology and Public Health (CIBERESP), Barcelona, Spain
  21. 21IB-Salut Menorca Health Area, Balearic Islands, Spain
  22. 22Departamento de Medicina, Universitat Jaume I, Castellon, Spain
  23. 23Public Health Department of Gipuzkoa, Gipuzkoa, Spain
  24. 24BIODONOSTIA Health Research Institute, San Sebastian, Spain
  25. 25Division of Pediatrics, Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden
  26. 26Department of Medicine and Health Sciences, Linköping University, Linköping, Sweden
  27. 27Center for Global Health, University of Illinois College of Medicine, Chicago, Illinois, USA
  28. 28Institute of Pediatrics, Obstetrics, and Gynecology, Kyiv, Ukraine
  1. Correspondence to Milagros Ruiz, Research Department of Epidemiology and Public Health, University College London, 1–19 Torrington Place, London WC1E 6BT, UK; milagros.ruiz.10{at}ucl.ac.uk

Abstract

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.

  • EPIDEMIOLOGY
  • CHILD HEALTH
  • INEQUALITIES

This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/

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