Exploring educational disparities in risk of preterm delivery: a comparative study of 12 European birth cohorts

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Gry Poulsen, Katrine Strandberg-Larsen, Laust Hvas Mortensen, Henrique Barros, Sylvaine Cordier, Sofia Correia, Asta Danileviciute, Manon van Eijsden, Ana Fernández-Somoano, Ulrike Gehring, Regina Grazuleviciene, Esther Hafkamp-de Groen, Tine Brink Henriksen, Morten Søndergaard Jensen, Isabel Larrañaga, Per Magnus, Kate Pickett, Hein Raat, Lorenzo Richiardi, Florence Rouget & 8 more Franca Rusconi, Camilla Stoltenberg, Eleonora P Uphoff, Tanja G M Vrijkotte, Alet H Wijga, Martine Vrijheid, Merete Osler, Anne-Marie Nybo Andersen

BACKGROUND: An association between education and preterm delivery has been observed in populations across Europe, but differences in methodology limit comparability. We performed a direct cross-cohort comparison of educational disparities in preterm delivery based on individual-level birth cohort data.

METHODS: The study included data from 12 European cohorts from Denmark, England, France, Lithuania, the Netherlands, Norway, Italy, Portugal, and Spain. The cohorts included between 2434 and 99 655 pregnancies. The association between maternal education and preterm delivery (22-36 completed weeks of gestation) was reported as risk ratios, risk differences, and slope indexes of inequality with 95% confidence intervals (CIs).

RESULTS: Singleton preterm live delivery proportion varied between 3.7% and 7.5%. There were large variations between the cohorts in the distribution of education and maternal characteristics. Nevertheless, there were similar educational differences in risk of preterm delivery in 8 of the 12 cohorts with slope index of inequality varying between 2.2 [95% CI 1.1, 3.3] and 4.0 [95% CI 1.4, 6.6] excess preterm deliveries per 100 singleton deliveries among the educationally most disadvantaged, and risk ratio between the lowest and highest education category varying from 1.4 [95% CI 1.1, 1.8] to 1.9 [95% CI 1.2, 3.1]. No associations were found in the last four cohorts.

CONCLUSIONS: Educational disparities in preterm delivery were found all over Europe. Despite differences in the distributions of education and preterm delivery, the results were remarkably similar across the cohorts. For those few cohorts that did not follow the pattern, study and country characteristics did not explain the differences.

Original languageEnglish
JournalPaediatric and Perinatal Epidemiology (Online)
Volume29
Issue number3
Pages (from-to)172-183
Number of pages12
ISSN1365-3016
DOIs
Publication statusPublished - May 2015

ID: 137669108