Abstract

Objective: Fetal growth is highly socially patterned and is related to health across the life course, but how the social patterns of fetal growth change over time remains understudied. We examined the time trends in maternal social disadvantage in relation to fetal growth in the context of a universal welfare state under changing macroeconomic conditions over a 24-year period.

Design and settings: All births in Denmark 1981-2004.

Main outcome measure: The association between maternal social disadvantage in relation to birth weight for gestational age z-scores over time were analysed using linear regression.

Results: All measures of social disadvantage were associated with decreased fetal growth (p < 0.001), but with considerable differences in the magnitude of the associations. The association was strongest for non-western ethnicity (-0.28 z-score), low education (-0.19), teenage motherhood (-0.14), single motherhood (-0.13), poverty (-0.12) and weakest for unemployment (-0.04). The deficit in fetal growth increased over time for all associations except for unemployment. Also, the measures of social adversity increasingly clustered within individuals over time.

Conclusion: Maternal social disadvantage is associated with decreased fetal growth in a welfare state. Social disadvantage is increasingly clustered so that fewer pregnancies are exposed, but those exposed suffer a greater disadvantage in fetal growth. The economic upturn in the last decade did not appear to weaken the association between maternal social disadvantage and decreased fetal growth.