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Does smoking during pregnancy mediate educational disparities in preterm delivery? Findings from three large birth cohorts

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Poulsen, Gry ; Andersen, Anne-Marie Nybo ; Jaddoe, Vincent W V ; Magnus, Per ; Raat, Hein ; Stoltenberg, Camilla ; Osler, Merete ; Mortensen, Laust Hvas. / Does smoking during pregnancy mediate educational disparities in preterm delivery? Findings from three large birth cohorts. I: Paediatric and Perinatal Epidemiology (Print). 2019 ; Bind 33, Nr. 2. s. 164-171.

Bibtex

@article{a073782891264d7fabfd69db9abc3436,
title = "Does smoking during pregnancy mediate educational disparities in preterm delivery?: Findings from three large birth cohorts",
abstract = "BACKGROUND: Socio-economic disparities in preterm delivery have often been attributed to socially patterned smoking habits. However, most existing studies have used methods that potentially give biased estimates of the mediating effect of smoking. We used a contemporary mediation approach to study to which extent smoking during pregnancy mediates educational disparities in preterm delivery.METHODS: We performed a comparative analysis of data from three large birth cohort studies: the Danish National Birth Cohort (DNBC), the Dutch Generation R Study, and the Norwegian Mother and Child Cohort Study (MoBa). Risk of preterm delivery by maternal education is reported as risk differences and decomposed into a part explained by smoking and a part explained by other pathways.RESULTS: Proportions of preterm singleton deliveries were 4.8{\%}-4.9{\%} in all three cohorts. Total effects of maternal education were 2.0 (95{\%} confidence interval [CI] 1.4, 2.5), 3.2 (95{\%} CI 0.8, 5.2) and 2.0 (95{\%} CI 0.9, 3.0) excess preterm deliveries per 100 singleton deliveries in DNBC, Generation R and MoBa when comparing primary/lower secondary education to an academic degree or equivalent. Smoking mediated, respectively, 22{\%}, 10{\%} and 19{\%} of the excess risk in the DNBC, Generation R and MoBa cohorts. Adjustment for potential misclassification of smoking only increased mediated proportions slightly.CONCLUSIONS: Smoking during pregnancy explains part of educational disparities in preterm delivery, but the mediated proportion depends on the educational gradient in smoking, emphasising that educational disparities in preterm birth may be mediated by different risk factors in different countries.",
keywords = "birth cohort, comparative study, educational disparities, mediation analysis, preterm delivery, smoking during pregnancy, socio-economic disparities",
author = "Gry Poulsen and Andersen, {Anne-Marie Nybo} and Jaddoe, {Vincent W V} and Per Magnus and Hein Raat and Camilla Stoltenberg and Merete Osler and Mortensen, {Laust Hvas}",
note = "{\circledC} 2019 John Wiley & Sons Ltd.",
year = "2019",
month = "3",
doi = "10.1111/ppe.12544",
language = "English",
volume = "33",
pages = "164--171",
journal = "Paediatric and Perinatal Epidemiology (Print)",
issn = "0269-5022",
publisher = "Wiley-Blackwell Publishing Ltd",
number = "2",

}

RIS

TY - JOUR

T1 - Does smoking during pregnancy mediate educational disparities in preterm delivery?

T2 - Findings from three large birth cohorts

AU - Poulsen, Gry

AU - Andersen, Anne-Marie Nybo

AU - Jaddoe, Vincent W V

AU - Magnus, Per

AU - Raat, Hein

AU - Stoltenberg, Camilla

AU - Osler, Merete

AU - Mortensen, Laust Hvas

N1 - © 2019 John Wiley & Sons Ltd.

PY - 2019/3

Y1 - 2019/3

N2 - BACKGROUND: Socio-economic disparities in preterm delivery have often been attributed to socially patterned smoking habits. However, most existing studies have used methods that potentially give biased estimates of the mediating effect of smoking. We used a contemporary mediation approach to study to which extent smoking during pregnancy mediates educational disparities in preterm delivery.METHODS: We performed a comparative analysis of data from three large birth cohort studies: the Danish National Birth Cohort (DNBC), the Dutch Generation R Study, and the Norwegian Mother and Child Cohort Study (MoBa). Risk of preterm delivery by maternal education is reported as risk differences and decomposed into a part explained by smoking and a part explained by other pathways.RESULTS: Proportions of preterm singleton deliveries were 4.8%-4.9% in all three cohorts. Total effects of maternal education were 2.0 (95% confidence interval [CI] 1.4, 2.5), 3.2 (95% CI 0.8, 5.2) and 2.0 (95% CI 0.9, 3.0) excess preterm deliveries per 100 singleton deliveries in DNBC, Generation R and MoBa when comparing primary/lower secondary education to an academic degree or equivalent. Smoking mediated, respectively, 22%, 10% and 19% of the excess risk in the DNBC, Generation R and MoBa cohorts. Adjustment for potential misclassification of smoking only increased mediated proportions slightly.CONCLUSIONS: Smoking during pregnancy explains part of educational disparities in preterm delivery, but the mediated proportion depends on the educational gradient in smoking, emphasising that educational disparities in preterm birth may be mediated by different risk factors in different countries.

AB - BACKGROUND: Socio-economic disparities in preterm delivery have often been attributed to socially patterned smoking habits. However, most existing studies have used methods that potentially give biased estimates of the mediating effect of smoking. We used a contemporary mediation approach to study to which extent smoking during pregnancy mediates educational disparities in preterm delivery.METHODS: We performed a comparative analysis of data from three large birth cohort studies: the Danish National Birth Cohort (DNBC), the Dutch Generation R Study, and the Norwegian Mother and Child Cohort Study (MoBa). Risk of preterm delivery by maternal education is reported as risk differences and decomposed into a part explained by smoking and a part explained by other pathways.RESULTS: Proportions of preterm singleton deliveries were 4.8%-4.9% in all three cohorts. Total effects of maternal education were 2.0 (95% confidence interval [CI] 1.4, 2.5), 3.2 (95% CI 0.8, 5.2) and 2.0 (95% CI 0.9, 3.0) excess preterm deliveries per 100 singleton deliveries in DNBC, Generation R and MoBa when comparing primary/lower secondary education to an academic degree or equivalent. Smoking mediated, respectively, 22%, 10% and 19% of the excess risk in the DNBC, Generation R and MoBa cohorts. Adjustment for potential misclassification of smoking only increased mediated proportions slightly.CONCLUSIONS: Smoking during pregnancy explains part of educational disparities in preterm delivery, but the mediated proportion depends on the educational gradient in smoking, emphasising that educational disparities in preterm birth may be mediated by different risk factors in different countries.

KW - birth cohort

KW - comparative study

KW - educational disparities

KW - mediation analysis

KW - preterm delivery

KW - smoking during pregnancy

KW - socio-economic disparities

UR - http://www.scopus.com/inward/record.url?scp=85063516684&partnerID=8YFLogxK

U2 - 10.1111/ppe.12544

DO - 10.1111/ppe.12544

M3 - Journal article

VL - 33

SP - 164

EP - 171

JO - Paediatric and Perinatal Epidemiology (Print)

JF - Paediatric and Perinatal Epidemiology (Print)

SN - 0269-5022

IS - 2

ER -

ID: 56927269