Abstract
ObjectiveSocioeconomic 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 DesignThis 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.ResultsLeast 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.ConclusionsSmoking 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.
Highlights
Adverse perinatal outcomes, such as preterm birth (PTB), low birth weight (LBW), and small for gestational age (SGA), are strongly related to neonatal morbidity as well as future adult morbidity
Smoking explains to a considerable extent the association between lower maternal education and adverse perinatal outcomes
Tobacco-interventions in lower educated women should be primarily focussed on maternal smoking to reduce PTB, LBW, and SGA
Summary
Adverse perinatal outcomes, such as preterm birth (PTB), low birth weight (LBW), and small for gestational age (SGA), are strongly related to neonatal morbidity as well as future adult morbidity. PTB may result in ophthalmologic, pulmonary, cognitive, behavioural or emotional problems [1], while LBW and SGA may increase the risk of cardiovascular disease, type 2 diabetes and psychomotor and intellectual impairment [2,3]. All these adverse perinatal outcomes lead to increased perinatal mortality [4]. A lower SES has no direct effect on adverse perinatal outcomes; rather it may be associated with adverse risk behaviour, such as greater tobacco exposure
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