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Paternal education and adverse birth outcomes in Canada
  1. Gabriel D Shapiro1,
  2. Tracey Bushnik2,
  3. Amanda J Sheppard3,
  4. Michael S Kramer1,4,
  5. Jay S Kaufman1,
  6. Seungmi Yang1
  1. 1Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Quebec, Canada
  2. 2Statistics Canada, Ottawa, Ontario, Canada
  3. 3Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
  4. 4Department of Pediatrics, McGill University, Montreal, Quebec, Canada
  1. Correspondence to Dr Gabriel Shapiro, Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Purvis Hall, 1020 Pine Ave West, Room 16A, Montreal, Quebec, Canada H3A 1A2; gabriel.shapiro{at}


Background Research on predictors of adverse birth outcomes has focused on maternal characteristics. Much less is known about the role of paternal factors. Paternal education is an important socioeconomic marker that may predict birth outcomes over and above maternal socioeconomic indicators.

Methods Using data from the 2006 Canadian Birth-Census Cohort, we estimated the associations between paternal education and preterm birth, small-for-gestational-age (SGA) birth, stillbirth and infant mortality in Canada, controlling for maternal characteristics. Binomial regression was used to estimate risk ratios and risk differences for adverse birth outcomes associated with paternal education, after controlling for maternal education, age, marital status, parity, ethnicity and nativity.

Results A total of 131 285 singleton births were included in the present study. Comparing the lowest to the highest paternal education category, adjusted risk ratios (95% CIs) were 1.22 (1.10 to 1.35) for preterm birth, 1.13 (1.03 to 1.23) for SGA birth, 1.92 (1.28 to 2.86) for stillbirth and 1.67 (1.01 to 2.75) for infant mortality. Consistent patterns of associations were observed for absolute risk differences.

Conclusions Our study suggests that low paternal education increases the risk of adverse birth outcomes, and especially of fetal and infant mortality, independently from maternal characteristics.


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  • Contributors GDS conducted the analyses and drafted and revised the manuscript; TB supervised linkage of the census and birth/death registration data, and contributed to revisions of the manuscript; AJS contributed to revisions of the manuscript; MSK designed the Canadian Birth-Census Cohort, directed its implementation and contributed to the design and revisions of the manuscript; JSK and SY contributed to the design and revisions of the manuscript. All the authors read and approved the final manuscript.

  • Funding Major funding for this study was provided by the Canadian Institutes of Health Research (MOP-111122), with additional support from Statistics Canada and Health Canada (Air Health Effects Research, Population Studies Division).

  • Competing interests None declared.

  • Ethics approval Statistics Canada Executive Management Board, Pediatric Research Ethics Board of the McGill University Health Centre Research Institute.

  • Provenance and peer review Not commissioned; externally peer reviewed.