| Author | Year of birth of study children | Maternal employment measure (prevalence %) and comparator | Health indicator | Unadjusted OR | Adjusted OR | Variables included in adjusted analysis | Quality rating† |
| Year of publication | Sample population | (95% CI) | (95% CI)* | ||||
| Study design | Setting/data source % single mothers | (OR>1 indicates poorer health outcome) | (OR>1 indicates poorer health outcome) | ||||
| Butler361986Cohort | 1970Children (n = 13135) aged 5 yearsBritish Births Survey, UK3.9% | Mother employed during the child’s life (54.5%) vs not employed during the child’s life | Not vaccinated against measles or pertussis | Measles: 1.15 (1.07 to 1.23)††Pertussis: 0.93 (0.81 to 1.07)†† | Measles: No significant association after indirect standardisationPertussis: No adjusted analysis | Region of the country. Number of household moves.Number of other children.Maternal smoking.Type of neighbourhood | II AAA |
| Adjaye301981Cross-sectional | 1973–76Mothers (n = 258) of children aged 27–74 monthsSouth London, UKN/R | Mother’s working status (categories and prevalence not stated) | Not vaccinated against measles | No significant association (OR not reported) | No adjusted analysis | N/A | I A |
| Coreil371998Cohort | 1984¶Mothers (n = 5212) of children aged 5 yearsPublic schools in Florida, USAN/R | Mother working ⩾21 hours per week [54.3%] vs working <21 hours per week | Incomplete vaccination at time of school entry | No data available | 0.94 (p>0.67) | Mother’s age/education. Household income. Child’s gender/ethnicity. Number of siblings living at home | II AAA |
| Jones391994Cross-sectional | 1988–90¶Children (n = 208) aged 2–4 yearsMilitary hospital-based paediatric clinic, USA9% | Both parents employed full-time (39.7%) vs not employed full-time | Not optimally vaccinated before second birthday | 1.78 (0.84 to 3.78)†† | No adjusted analysis | N/A | II AA |
| Wood251995Cross-sectional | 1989–91¶Children aged 12–36 months, of African American (n = 301) or Latino (n = 724) ethnic originLos Angeles, USAAfrican American = 57%, Latino = 26% | Mother working (African American mothers = 30%; Latino mothers = 19%) vs not working | a) Not in receipt of all required vaccines at age 3 monthsb) Not in receipt of all required vaccines at 24 months | a) African American: association, p<0.1 (OR and direction not reported)Latino: association, p<0.1 (OR and direction not reported)b) Association for both ethnic groups, p<0.1 (OR and direction not reported) | a) African American: 0.50 (0.27 to 0.91)††Latino: no significant association (OR not reported)b) No significant association for either ethnic group (OR not reported) | a) Both ethnic groups: number of pre-school children in household. Child age/gender/health status. Family income. Mother’s marital status/education. Health insurance. Source of well-child care. Family mobilityAdditional variables included for the African American§ and Latino ethnic groups**b) Both ethnic groups: child age/health status. Mother’s marital status/education. Source of well-child careAdditional variables included for the African American§ and Latino ethnic groups** | II AA |
| Impicciatore382000Cross-sectional | 1990–96¶Mothers [n = 1035] of children aged 3.6 months-6.4 yearsPublic spaces in three urban/three rural areas, ItalyN/R | Mother has part-time or full-time job (53%) vs unemployed | Not fully vaccinated (or up to date) against MMR or pertussis | MMR:0.58 (0.45 to 0.75)††Pertussis:0.78 (0.61 to 1.00)†† | MMR:No significant association (OR not reported)Pertussis:No significant association (OR not reported) | Mother’s residency/educational level/age/attitude towards immunisation. Setting. Family size. Child’s position in family. Year of child immunisation. Information on immunisation | II A |
| Alio272005Cross-sectional | 1991–2000Children (n = 10525) aged 0–5 years1996–2000 Medical Expenditure Panel Survey public use files, USABlack = 60%, White = 24% | Mother employed (Black mothers = 67.1%; White mothers = 63%) vs not employed | Not receiving preventive care (including up to date vaccination) | No data available | 0.96 (0.84 to 1.09) | Mother’s race/insurance coverage/age/education. Family size | III AAA |
| The following two papers analysed data collected in the same study | |||||||
| Bates321994Cohort | 1992Mothers (n = 500) of children aged 0–12 monthsLarge municipal teaching hospital, Midwest USA72% | Mother employed (24%) vs not employed | Not up to date with vaccination at age 3 and 7 months | At age 3 months:0.92 (0.58 to 1.44)‡At age 7 months:0.82 (0.52 to 1.30)‡ | Adjusted analysis does not include maternal employment variable | N/A | II AAA |
| Bates331998Cohort | 1992Mothers (n = 500) of children aged 24–30 monthsLarge municipal teaching hospital, Midwest USA71% | Mother’s employment (categories and prevalence not stated) | Not up to date with vaccination at age 2 years | No significant association (paper presents neither OR nor data required to calculate OR) | Adjusted analysis does not include maternal employment variable | N/A | II AAA |
| Brenner352001Cohort | 1994–95¶Mothers (n = 452) of children aged 0–12 monthsThree hospitals in the District of Columbia, USA71% | Mother employed postpartum (37%) vs not employed (including students) | Not up to date with vaccination at age 3 and 7 months | At age 3 months:0.64 (0.37 to 1.11)‡At age 7 months:0.53 (0.34 to 0.85)‡ | At age 3 months:adjusted analysis does not include maternal employment variableAt age 7 months:0.52 (0.31 to 0.87)‡ | At age 3 months:N/AAt age 7 months:Child birth order/birthweight. Mother’s drug use. Intended infant sleeping position. Someone in home with a drug problem. WIC during pregnancy | II AA |
| Bond341999Cross-sectional | 1994–97¶Children (n = 1779) aged 0–35 monthsCouncil-run family day care or centre-based care in Melbourne, Australia13% | Mother in paid employment (80%) vs no paid employment | Incomplete or no vaccination | 0.67 (0.48 to 0.90) | Maternal employment variable not listed as significantly associated with vaccination; unclear whether or not it was included in adjusted analysis | See previous column | II AA |
| Matsumura262005Cross-sectional | 1998–2000¶Children (n = 5047)Health check-ups at age 18 months or 36 months in Kyoto City, JapanN/R | Mother working (25% at 18 months; 33.3% at 36 months) vs not working | Incomplete vaccination against measles at age 18 or 36 months | At age 18 months:1.66 (1.37 to 2.01)At age 36 months:2.60 (1.95 to 3.49) | At age 18 months:1.38 (1.00 to 1.89)At age 36 months:1.75 (1.16 to 2.66) | Mother’s age/concern about the adverse effects of measles/knowledge of measles. Not the firstborn child. Child’s interaction with other children. Presence of allergies in child | III AAA |
| Iordanou312006Cross-sectional | <2000¶Children (n = 500) aged 5–6 years at primary school entrySelected areas of Greece4% | Mother’s profession (various categories = 44%) vs mother as ‘housekeeper’ | Incomplete or no vaccination against diphtheria, tetanus and pertussis | DTP and DT vaccines:rates of incomplete or no vaccination higher among employed mothers, p<0.002 (OR not reported) | DTP and DT vaccines:1.34‡ (CI not reported) | Unclear | I A |
| Samad402006Cohort | 2000–02Children (n = 18488) aged 9 monthsMillennium Cohort Study, UK17% | Mother has returned to or started work since birth of cohort baby (46%) vs not returned to or started work since birth of cohort baby | Partially or not vaccinated at age 9 months | No data available | Partially vaccinated:rate ratio = 0.7 (0.6 to 0.8)Not vaccinated:rate ratio = 0.6 (0.4 to 0.8) | Mother’s age at birth of cohort child/education/smoking/ethnic group. Family size. Country of UK. Ward type. Lone parenthood. Infant’s hospital admission | II AAA |
| Theeten412007Cross-sectional | 2003Children (n = 1349) aged 18–24 monthsFlanders, BelgiumN/R | a) Mother in full-time salaried employment (33%) vs not workingb) Mother in less than full-time employment or freelance (39%) vs not working | Not in receipt of complete, valid (correctly timed) vaccination schedule | No data available | a) 0.56 (0.42 to 0.77)‡b) 0.91 (0.67 to 1.25)‡ | Maternal and paternal age/educational level. Main vaccinator. Province of residence. Family income. Age of the child. Use of day care. Number of siblings | II AAA |
CI, confidence intervals; DT, diphtheria and tetanus vaccine; DTP, diphtheria, tetanus and pertussis vaccine; MMR, measles, mumps and rubella vaccine; N/A, not applicable; N/R, not recorded; OR, odds ratio; WIC, Special Nutrition Program for Women, Infants and Children.
*95% confidence intervals, unless otherwise stated.
†III = strong internal validity (four or more domains strong or three domains strong and none weak); I = weak internal validity (three or more domains weak); II = moderate internal validity (those not fulfilling criteria for strong or weak). AAA = findings likely to be applicable across a broad range of populations and settings (but may need appropriate adaptation); AA = findings applicable only to populations and settings included in the study – success of broader application is uncertain; A = applicable only to populations and settings included in the study.
‡Odds ratio calculated by review authors using data derived from the published paper.
¶Estimated year of birth of study children.
§Analyses at 3 months = receipt of immunisation information from friends/relatives, given appointment in hospital for first well child visit, and mother’s use of preventive services; analyses at 24 months = family mobility and patient satisfaction with care.
**Analyses at 3 months = ‘shot’ (ie vaccination) information from the media, number of family financial difficulties reported, belief that shots prevent colds/diarrhoea, use of seatbelt, percentage of pre-school children on WIC, receipt of six or more prenatal visits, and sampling area; analyses at 24 months = number of pre-school children in household and sampling area.