Smoking overrules many other risk factors for small for gestational age birth in less educated mothers |
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Authors: | Gerrit van den Berg Manon van Eijsden Francisca Galindo-Garre Tanja GM Vrijkotte Reinoud JBJ Gemke |
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Institution: | 1. Department of Pediatrics, VU University Medical Center Amsterdam, The Netherlands;2. Department of Epidemiology, Documentation and Health Promotion, Public Health Service, Amsterdam, The Netherlands;3. Department of Health Sciences, VU University Amsterdam, The Netherlands;4. Department of Epidemiology and Biostatistics, VU University Medical Center, Amsterdam, The Netherlands;5. Department of Public Health, Academic Medical Center, University of Amsterdam, The Netherlands |
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Abstract: | BackgroundAlthough there is convincing evidence for the association between small for gestational age (SGA) and socioeconomic status (SES), it is not known to what extent explanatory factors contribute to this association.AimTo examine to what extent risk factors could explain educational inequalities in SGA.Study designIn this study fully completed data were available for 3793 pregnant women of Dutch origin from a population-based cohort (ABCD study). Path-analysis was conducted to examine the role of explanatory factors in the relation of maternal education to SGA.ResultsLow-educated pregnant women had a higher risk of SGA offspring compared to the high-educated women (OR 1.98, 95% CI 1.35–2.89). In path-analysis, maternal cigarette smoking and maternal height explained this association. Maternal age, hypertension, chronic disease, late entry into antenatal care, neighborhood income, underweight, environmental cigarette smoking, drug abuse, alcohol use, caffeine intake, fish intake, folic acid intake, anxiety, and depressive symptoms did not play a role in the association between maternal education and SGA birth.ConclusionAmong a large array of potential factors, the elevated risk of SGA birth among low-educated women appeared largely attributable to maternal smoking and to a lesser extent to maternal height. To reduce educational inequalities more effort is required to include low-educated women especially in prenatal intervention programs such as smoking cessation programs instead of effort into reducing other SGA-risk factors, though these factors might still be relevant at the individual level. |
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Keywords: | Cohort Explanatory factors Maternal education Small for gestational age Smoking Socioeconomic status Path-analysis |
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