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) = 1.89 (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 OR = 1.10 (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.

dx.doi.org/10.1136/adc.2007.136945, hdl.handle.net/1765/12699
Archives of Disease in Childhood: an international peer-reviewed journal for health professionals and researchers covering conception to adolescence
Erasmus MC: University Medical Center Rotterdam

Jansen, P.W, Tiemeier, H.W, Jaddoe, V.W.V, Hofman, A, Steegers, E.A.P, Verhulst, F.C, … Raat, H. (2008). Explaining Educational Inequalities in Preterm Birth. The Generation R Study. Archives of Disease in Childhood: an international peer-reviewed journal for health professionals and researchers covering conception to adolescence, 1–23. doi:10.1136/adc.2007.136945