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Educational Inequalities in Perinatal Outcomes: The Mediating Effect of Smoking and Environmental Tobacco Exposure

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  • Gerrit van den Berg
  • Manon van Eijsden
  • Tanja G M Vrijkotte
  • Reinoud J B J Gemke

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.

Suggested Citation

  • Gerrit van den Berg & Manon van Eijsden & Tanja G M Vrijkotte & Reinoud J B J Gemke, 2012. "Educational Inequalities in Perinatal Outcomes: The Mediating Effect of Smoking and Environmental Tobacco Exposure," PLOS ONE, Public Library of Science, vol. 7(5), pages 1-6, May.
    • Handle: RePEc:plo:pone00:0037002
    DOI: 10.1371/journal.pone.0037002
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    References listed on IDEAS

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    1. Caren I Lanting & Simone E Buitendijk & Matty R Crone & Dewi Segaar & Jack Bennebroek Gravenhorst & Jacobus P van Wouwe, 2009. "Clustering of Socioeconomic, Behavioural, and Neonatal Risk Factors for Infant Health in Pregnant Smokers," PLOS ONE, Public Library of Science, vol. 4(12), pages 1-6, December.
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    Cited by:

    1. Allison A Appleton & David A Armstrong & Corina Lesseur & Joyce Lee & James F Padbury & Barry M Lester & Carmen J Marsit, 2013. "Patterning in Placental 11-B Hydroxysteroid Dehydrogenase Methylation According to Prenatal Socioeconomic Adversity," PLOS ONE, Public Library of Science, vol. 8(9), pages 1-7, September.

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