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Educational Inequalities in Perinatal Outcomes: The Mediating Effect of Smoking and Environmental Tobacco Exposure
- Source :
- PLoS ONE, 7(5):e37002. Public Library of Science, PLoS ONE, 7(5). Public Library of Science, PLoS ONE, Vol 7, Iss 5, p e37002 (2012), PLoS ONE, van den Berg, G, van Eijsden, M, Vrijkotte, T G M & Gemke, R J B J 2012, ' Educational Inequalities in Perinatal Outcomes: The Mediating Effect of Smoking and Environmental Tobacco Exposure ', PLoS ONE, vol. 7, no. 5, e37002 . https://doi.org/10.1371/journal.pone.0037002
- Publication Year :
- 2012
-
Abstract
- OBJECTIVE: Socioeconomic status (SES) is adversely associated with perinatal outcomes. This association is likely to be mediated by tobacco exposure. However, previous studies were limited to single perinatal outcomes and devoted no attention to environmental tobacco exposure. Therefore, this study aimed firstly to explain the role of maternal smoking in the association between maternal education and preterm birth (PTB), low birth weight (LBW) and small for gestational age (SGA), and secondly to explain whether environmental tobacco smoke mediates these associations further. STUDY DESIGN: This study was nested in a population-based cohort study in the Netherlands, the Amsterdam Born Children and their Development (ABCD) study. Analyses were done in a sample of 3821 pregnant women of Dutch origin, using logistic regression analysis. RESULTS: Least educated women, who were more often smoking and exposed to environmental tobacco smoke, had a significantly higher risk of PTB (OR 1.95 [95% CI: 1.19-3.20]), LBW (OR 2.41 [95% CI: 1.36-4.27]) and SGA (OR 1.90 [95% CI 1.32-2.74]) than highly educated women. The mediating effect of smoking in the least educated women was 43% for PTB, 55% for LBW and 66% for SGA. Environmental tobacco smoke did not explain these associations further. After adjustment for maternal smoking, the association between lower maternal education and pregnancy outcomes was no longer significant. CONCLUSIONS: Smoking explains to a considerable extent the association between lower maternal education and adverse perinatal outcomes. Therefore, tobacco-interventions in lower educated women should be primarily focussed on maternal smoking to reduce PTB, LBW, and SGA. Additional attention to environmental tobacco exposure does not seem to reduce educational inequalities in perinatal outcomes.
- Subjects :
- Pulmonology
Epidemiology
lcsh:Medicine
Pediatrics
Tobacco smoke
Cohort Studies
Pregnancy
Morphogenesis
Medicine
lcsh:Science
Health Education
Netherlands
education.field_of_study
Multidisciplinary
Obstetrics
Smoking
Obstetrics and Gynecology
Socioeconomic Aspects of Health
Premature birth
Infant, Small for Gestational Age
Premature Birth
Female
Public Health
medicine.symptom
Research Article
Cohort study
Adult
medicine.medical_specialty
Tobacco Control
Birth weight
Population
Environmental health
Humans
education
Biology
Socioeconomic status
business.industry
lcsh:R
Infant, Newborn
Smoking Related Disorders
Infant, Low Birth Weight
medicine.disease
Social Epidemiology
Low birth weight
Small for gestational age
Tobacco Smoke Pollution
lcsh:Q
Neonatology
business
Developmental Biology
Subjects
Details
- ISSN :
- 19326203
- Volume :
- 7
- Issue :
- 5
- Database :
- OpenAIRE
- Journal :
- PLoS ONE
- Accession number :
- edsair.doi.dedup.....183321ccb067f27142660e08f0dd86af