Meta-Analysis

. 2015 Sep;69(9):826-33.

doi: 10.1136/jech-2014-205387. Epub 2015 Apr 24.

Mother's education and the risk of preterm and small for gestational age birth: a DRIVERS meta-analysis of 12 European cohorts

Milagros Ruiz¹, Peter Goldblatt², Joana Morrison¹, Lubomír Kukla³, Jan Švancara⁴, Marjo Riitta-Järvelin⁵, Anja Taanila⁶, Marie-Josèphe Saurel-Cubizolles⁷, Sandrine Lioret⁸, Chryssa Bakoula⁹, Alexandra Veltsista⁹, Daniela Porta¹⁰, Francesco Forastiere¹⁰, Manon van Eijsden¹¹, Tanja G M Vrijkotte¹², Merete Eggesbø¹³, Richard A White¹³, Henrique Barros¹⁴, Sofia Correia¹⁴, Martine Vrijheid¹⁵, Maties Torrent¹⁶, Marisa Rebagliato¹⁷, Isabel Larrañaga¹⁸, Johnny Ludvigsson¹⁹, Åshild Olsen Faresjö²⁰, Daniel Hryhorczuk²¹, Youriy Antipkin²², Michael Marmot²³, Hynek Pikhart¹

Affiliations

¹ Research Department of Epidemiology and Public Health, University College London, London, UK.
² Research Department of Epidemiology and Public Health, UCL Institute of Health Equity, University College London, London, UK.
³ Faculty of Science, Research Centre for Toxic Compounds in the Environment (RECETOX), Masaryk University, Brno, Czech Republic.
⁴ Faculty of Science, Research Centre for Toxic Compounds in the Environment (RECETOX), Masaryk University, Brno, Czech Republic Faculty of Medicine, Institute of Biostatistics and Analyses, Masaryk University, Brno, Czech Republic.
⁵ Department of Epidemiology and Biostatistics, MRC Health Protection Agency (HPE), Centre for Environment and Health, School of Public Health, Imperial College London, London, UK Unit of Primary Care, Oulu University Hospital, Oulu, Finland Center for Life Course Epidemiology, Faculty of Medicine, University of Oulu, Oulu, Finland Institute of Health Sciences, University of Oulu, Oulu, Finland.
⁶ Biocenter Oulu, University of Oulu, Oulu, Finland.
⁷ Institut National de la Santé et de la Recherche Médicale (INSERM) UMR 1153, Obstetrical, Perinatal and Pediatric Epidemiology Research Team (Epopé), Center for Epidemiology and Statistics, Sorbonne Paris Cité, DHU Risks in Pregnancy, Paris Descartes University, Paris, France.
⁸ Institut National de la Santé et de la Recherche Médicale (INSERM) UMR 1153, Early Origin of the Child's Health and Development Team (ORCHAD), Center for Epidemiology and Statistics, Sorbonne Paris Cité, Paris Descartes University, Paris, France.
⁹ First Department of Paediatrics, University of Athens, Aghia Sophia Children's Hospital, Athens, Greece.
¹⁰ Department of Epidemiology of the Lazio Regional Health System, Rome, Italy.
¹¹ Department of Epidemiology and Health Promotion, Public Health Service of Amsterdam, Amsterdam, The Netherlands.
¹² Department of Public Health, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.
¹³ Department of Genes and Environment, Norwegian Institute of Public Health, Oslo, Norway.
¹⁴ Department of Clinical Epidemiology, Predictive Medicine and Public Health, University of Porto Medical School, Porto, Portugal EPIUnit - Institute of Public Health, University of Porto, Porto, Portugal.
¹⁵ Center for Research in Environmental Epidemiology (CREAL), Barcelona, Spain Spanish Consortium for Research on Epidemiology and Public Health (CIBERESP), Barcelona, Spain.
¹⁶ Spanish Consortium for Research on Epidemiology and Public Health (CIBERESP), Barcelona, Spain IB-Salut Menorca Health Area, Balearic Islands, Spain.
¹⁷ Spanish Consortium for Research on Epidemiology and Public Health (CIBERESP), Barcelona, Spain Departamento de Medicina, Universitat Jaume I, Castellon, Spain.
¹⁸ Public Health Department of Gipuzkoa, Gipuzkoa, Spain BIODONOSTIA Health Research Institute, San Sebastian, Spain.
¹⁹ Division of Pediatrics, Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden.
²⁰ Department of Medicine and Health Sciences, Linköping University, Linköping, Sweden.
²¹ Center for Global Health, University of Illinois College of Medicine, Chicago, Illinois, USA.
²² Institute of Pediatrics, Obstetrics, and Gynecology, Kyiv, Ukraine.
²³ Research Department of Epidemiology and Public Health, University College London, London, UK Research Department of Epidemiology and Public Health, UCL Institute of Health Equity, University College London, London, UK.

PMID: 25911693
PMCID: PMC4552914
DOI: 10.1136/jech-2014-205387

Meta-Analysis

Mother's education and the risk of preterm and small for gestational age birth: a DRIVERS meta-analysis of 12 European cohorts

Milagros Ruiz et al. J Epidemiol Community Health. 2015 Sep.

. 2015 Sep;69(9):826-33.

doi: 10.1136/jech-2014-205387. Epub 2015 Apr 24.

Authors

Affiliations

¹ Research Department of Epidemiology and Public Health, University College London, London, UK.
² Research Department of Epidemiology and Public Health, UCL Institute of Health Equity, University College London, London, UK.
³ Faculty of Science, Research Centre for Toxic Compounds in the Environment (RECETOX), Masaryk University, Brno, Czech Republic.
⁴ Faculty of Science, Research Centre for Toxic Compounds in the Environment (RECETOX), Masaryk University, Brno, Czech Republic Faculty of Medicine, Institute of Biostatistics and Analyses, Masaryk University, Brno, Czech Republic.
⁵ Department of Epidemiology and Biostatistics, MRC Health Protection Agency (HPE), Centre for Environment and Health, School of Public Health, Imperial College London, London, UK Unit of Primary Care, Oulu University Hospital, Oulu, Finland Center for Life Course Epidemiology, Faculty of Medicine, University of Oulu, Oulu, Finland Institute of Health Sciences, University of Oulu, Oulu, Finland.
⁶ Biocenter Oulu, University of Oulu, Oulu, Finland.
⁷ Institut National de la Santé et de la Recherche Médicale (INSERM) UMR 1153, Obstetrical, Perinatal and Pediatric Epidemiology Research Team (Epopé), Center for Epidemiology and Statistics, Sorbonne Paris Cité, DHU Risks in Pregnancy, Paris Descartes University, Paris, France.
⁸ Institut National de la Santé et de la Recherche Médicale (INSERM) UMR 1153, Early Origin of the Child's Health and Development Team (ORCHAD), Center for Epidemiology and Statistics, Sorbonne Paris Cité, Paris Descartes University, Paris, France.
⁹ First Department of Paediatrics, University of Athens, Aghia Sophia Children's Hospital, Athens, Greece.
¹⁰ Department of Epidemiology of the Lazio Regional Health System, Rome, Italy.
¹¹ Department of Epidemiology and Health Promotion, Public Health Service of Amsterdam, Amsterdam, The Netherlands.
¹² Department of Public Health, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.
¹³ Department of Genes and Environment, Norwegian Institute of Public Health, Oslo, Norway.
¹⁴ Department of Clinical Epidemiology, Predictive Medicine and Public Health, University of Porto Medical School, Porto, Portugal EPIUnit - Institute of Public Health, University of Porto, Porto, Portugal.
¹⁵ Center for Research in Environmental Epidemiology (CREAL), Barcelona, Spain Spanish Consortium for Research on Epidemiology and Public Health (CIBERESP), Barcelona, Spain.
¹⁶ Spanish Consortium for Research on Epidemiology and Public Health (CIBERESP), Barcelona, Spain IB-Salut Menorca Health Area, Balearic Islands, Spain.
¹⁷ Spanish Consortium for Research on Epidemiology and Public Health (CIBERESP), Barcelona, Spain Departamento de Medicina, Universitat Jaume I, Castellon, Spain.
¹⁸ Public Health Department of Gipuzkoa, Gipuzkoa, Spain BIODONOSTIA Health Research Institute, San Sebastian, Spain.
¹⁹ Division of Pediatrics, Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden.
²⁰ Department of Medicine and Health Sciences, Linköping University, Linköping, Sweden.
²¹ Center for Global Health, University of Illinois College of Medicine, Chicago, Illinois, USA.
²² Institute of Pediatrics, Obstetrics, and Gynecology, Kyiv, Ukraine.
²³ Research Department of Epidemiology and Public Health, University College London, London, UK Research Department of Epidemiology and Public Health, UCL Institute of Health Equity, University College London, London, UK.

PMID: 25911693
PMCID: PMC4552914
DOI: 10.1136/jech-2014-205387

Abstract

Background: A healthy start to life is a major priority in efforts to reduce health inequalities across Europe, with important implications for the health of future generations. There is limited combined evidence on inequalities in health among newborns across a range of European countries.

Methods: Prospective cohort data of 75 296 newborns from 12 European countries were used. Maternal education, preterm and small for gestational age births were determined at baseline along with covariate data. Regression models were estimated within each cohort and meta-analyses were conducted to compare and measure heterogeneity between cohorts.

Results: Mother's education was linked to an appreciable risk of preterm and small for gestational age (SGA) births across 12 European countries. The excess risk of preterm births associated with low maternal education was 1.48 (1.29 to 1.69) and 1.84 (0.99 to 2.69) in relative and absolute terms (Relative/Slope Index of Inequality, RII/SII) for all cohorts combined. Similar effects were found for SGA births, but absolute inequalities were greater, with an SII score of 3.64 (1.74 to 5.54). Inequalities at birth were strong in the Netherlands, the UK, Sweden and Spain and marginal in other countries studied.

Conclusions: This study highlights the value of comparative cohort analysis to better understand the relationship between maternal education and markers of fetal growth in different settings across Europe.

Keywords: CHILD HEALTH; EPIDEMIOLOGY; INEQUALITIES.

Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

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Figures

**Figure 1**
(A/B)—Cohort-specific, and pooled Relative/Slope Index of Inequality, RII and SII scores, in the meta-analysis of the association between maternal education and preterm birth.

**Figure 2**
(A/B)—Cohort-specific, and pooled Relative/Slope Index of Inequality, RII and SII scores, in the meta-analysis of the association between maternal education and small for gestational age birth.

See this image and copyright information in PMC

Comment in

Mother's education and adverse birth outcomes.
Tooth L, Mishra GD. Tooth L, et al. J Epidemiol Community Health. 2015 Sep;69(9):821-2. doi: 10.1136/jech-2015-205625. Epub 2015 Apr 9. J Epidemiol Community Health. 2015. PMID: 25858637 No abstract available.

References

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1. Gluckman PD, Hanson MA, Cooper C, et al. . Effect of in utero and early-life conditions on adult health and disease. N Engl J Med 2008;359:61–73. 10.1056/NEJMra0708473 - DOI - PMC - PubMed
1. Barker DJ, Gluckman PD, Godfrey KM, et al. . Fetal nutrition and cardiovascular disease in adult life. Lancet 1993;341:938–41. 10.1016/0140-6736(93)91224-A - DOI - PubMed
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Mother's education and the risk of preterm and small for gestational age birth: a DRIVERS meta-analysis of 12 European cohorts

Affiliations

Mother's education and the risk of preterm and small for gestational age birth: a DRIVERS meta-analysis of 12 European cohorts

Authors

Affiliations

Abstract

Figures

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