Social inequalities in pregnancy outcomes and early childhood behaviour: the Generation R study

aim of this thesis was to extend the existing knowledge on the relation of social disadvantage with pregnancy outcomes and early childhood behaviour. More specifically, we aimed to identify the mechanisms underlying this association. In this thesis, several indicators of social disadvantage are examined, namely low educational level, low income, unemployment (these three indicators are also labeled ‘low socioeconomic status’), and ethnic minority status. This thesis indicated that a large social gradient exists in pregnancy outcomes in women living in Rotterdam, the Netherlands: women with a low socioeconomic background, as compared to women with a high socioeconomic status, had an elevated risk of adverse pregnancy outcomes, such as slower fetal growth, preterm birth, and low birth weight. The inequalities were largely explained by a combination of risk factors for pregnancy complications among women with a low socioeconomic background, such as young age, short stature, smoking during pregnancy, experience of stress and psychosocial problems. Equally, we found a large social gradient in behaviour early in life with infants of low socioeconomic status displaying more temperamental difficulties, and toddlers of non-Dutch origin having higher levels of parent-reported behavioural problems. The social gradient was also observed in parenting style with parents of low SES or non-Dutch origin being more likely to harshly discipline their 3-year old children. The social gradient in early childhood behaviour was mainly explained by sociodemographic risk factors (e.g. young parental age, single motherhood) and indicators of stress and psychosocial problems of the parents. We also showed that the reported behavioural problems of non-Dutch toddlers were more pronounced among those with unfavourable maternal immigration characteristics, such as poor Dutch language skills and not feeling accepted by Dutch natives.

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