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Are socioeconomic inequalities in the incidence of small-for-gestational-age birth narrowing? Findings from a population-based cohort in the South of England

Are socioeconomic inequalities in the incidence of small-for-gestational-age birth narrowing? Findings from a population-based cohort in the South of England
Are socioeconomic inequalities in the incidence of small-for-gestational-age birth narrowing? Findings from a population-based cohort in the South of England

Objectives To investigate socioeconomic inequalities, using maternal educational attainment, maternal and partner employment status, and lone motherhood indicators, in the risk of small-for-gestational-age (SGA) births, their time trend, potential mediation by maternal smoking and body mass index, and effect modification by parity.

Design Population-based birth cohort using routine antenatal healthcare data.

Setting Babies born at University Hospital Southampton, UK, between 2004 and 2016.

Participants 65 909 singleton live births born to mothers aged ≥18 years between 24-week and 42-week gestation.

Main outcome measures SGA (birth weight <10th percentile for others born at the same number of completed weeks compared with 2013/2014 within England and Wales).

Results Babies born to mothers educated up to secondary school level (adjusted OR (aOR) 1.32, 99% CI 1.19 to 1.47), who were unemployed (aOR 1.27, 99% CI 1.16 to 1.38) or with unemployed partners (aOR 1.27, 99% CI 1.13 to 1.43), were at greater risk of being SGA. There was no statistically significant change in the magnitude of this risk difference by these indicators over time between 2004 and 2016, as estimated by linear interactions with year of birth. Babies born to lone mothers were not at higher risk compared with partnered mothers after adjusting for maternal smoking (aOR 1.05, 99% CI 0.93 to 1.20). The inverse association between maternal educational attainment and SGA risk appeared greater in multiparous (aOR 1.40, 99% CI 1.10 to 1.77) compared with primiparous women (aOR 1.28, 99% CI 1.12 to 1.47), and the reverse was true for maternal and partner’s unemployment where the association was stronger in primiparous women.

Conclusions Socioeconomic inequalities in SGA risk by educational attainment and employment status are not narrowing over time, with differences in association strength by parity. The greater SGA risk in lone mothers was potentially explained by maternal smoking. Preventive interventions should target socially disadvantaged women, including preconception and postpartum smoking cessation to reduce SGA risk.

2044-6055
1-13
Wilding, Sam
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Ziauddeen, Nida
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Roderick, Paul
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Smith, Dianna
e859097c-f9f5-4fd0-8b07-59218648e726
Chase, Debbie
d4f47e11-d0cd-4de7-afeb-9ebae1222fc9
Macklon, Nicholas
7db1f4fc-a9f6-431f-a1f2-297bb8c9fb7e
Mcgrath, Nuala
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Hanson, Mark
1952fad1-abc7-4284-a0bc-a7eb31f70a3f
Alwan, Nisreen
0d37b320-f325-4ed3-ba51-0fe2866d5382
Wilding, Sam
a026cae1-cc72-49b5-a52b-ec1d931d72e1
Ziauddeen, Nida
3ad67dd8-26ba-498a-af0a-b1174298995b
Roderick, Paul
dbb3cd11-4c51-4844-982b-0eb30ad5085a
Smith, Dianna
e859097c-f9f5-4fd0-8b07-59218648e726
Chase, Debbie
d4f47e11-d0cd-4de7-afeb-9ebae1222fc9
Macklon, Nicholas
7db1f4fc-a9f6-431f-a1f2-297bb8c9fb7e
Mcgrath, Nuala
b75c0232-24ec-443f-93a9-69e9e12dc961
Hanson, Mark
1952fad1-abc7-4284-a0bc-a7eb31f70a3f
Alwan, Nisreen
0d37b320-f325-4ed3-ba51-0fe2866d5382

Wilding, Sam, Ziauddeen, Nida, Roderick, Paul, Smith, Dianna, Chase, Debbie, Macklon, Nicholas, Mcgrath, Nuala, Hanson, Mark and Alwan, Nisreen (2019) Are socioeconomic inequalities in the incidence of small-for-gestational-age birth narrowing? Findings from a population-based cohort in the South of England. BMJ Open, 9 (7), 1-13, [e026998]. (doi:10.1136/bmjopen-2018-026998).

Record type: Article

Abstract

Objectives To investigate socioeconomic inequalities, using maternal educational attainment, maternal and partner employment status, and lone motherhood indicators, in the risk of small-for-gestational-age (SGA) births, their time trend, potential mediation by maternal smoking and body mass index, and effect modification by parity.

Design Population-based birth cohort using routine antenatal healthcare data.

Setting Babies born at University Hospital Southampton, UK, between 2004 and 2016.

Participants 65 909 singleton live births born to mothers aged ≥18 years between 24-week and 42-week gestation.

Main outcome measures SGA (birth weight <10th percentile for others born at the same number of completed weeks compared with 2013/2014 within England and Wales).

Results Babies born to mothers educated up to secondary school level (adjusted OR (aOR) 1.32, 99% CI 1.19 to 1.47), who were unemployed (aOR 1.27, 99% CI 1.16 to 1.38) or with unemployed partners (aOR 1.27, 99% CI 1.13 to 1.43), were at greater risk of being SGA. There was no statistically significant change in the magnitude of this risk difference by these indicators over time between 2004 and 2016, as estimated by linear interactions with year of birth. Babies born to lone mothers were not at higher risk compared with partnered mothers after adjusting for maternal smoking (aOR 1.05, 99% CI 0.93 to 1.20). The inverse association between maternal educational attainment and SGA risk appeared greater in multiparous (aOR 1.40, 99% CI 1.10 to 1.77) compared with primiparous women (aOR 1.28, 99% CI 1.12 to 1.47), and the reverse was true for maternal and partner’s unemployment where the association was stronger in primiparous women.

Conclusions Socioeconomic inequalities in SGA risk by educational attainment and employment status are not narrowing over time, with differences in association strength by parity. The greater SGA risk in lone mothers was potentially explained by maternal smoking. Preventive interventions should target socially disadvantaged women, including preconception and postpartum smoking cessation to reduce SGA risk.

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More information

Accepted/In Press date: 17 June 2019
e-pub ahead of print date: 29 July 2019

Identifiers

Local EPrints ID: 431917
URI: http://eprints.soton.ac.uk/id/eprint/431917
ISSN: 2044-6055
PURE UUID: 1a95d431-b34f-480c-84ea-7a1bda83a6b4
ORCID for Sam Wilding: ORCID iD orcid.org/0000-0003-4184-2821
ORCID for Paul Roderick: ORCID iD orcid.org/0000-0001-9475-6850
ORCID for Dianna Smith: ORCID iD orcid.org/0000-0002-0650-6606
ORCID for Nuala Mcgrath: ORCID iD orcid.org/0000-0002-1039-0159
ORCID for Mark Hanson: ORCID iD orcid.org/0000-0002-6907-613X
ORCID for Nisreen Alwan: ORCID iD orcid.org/0000-0002-4134-8463

Catalogue record

Date deposited: 21 Jun 2019 16:30
Last modified: 03 Dec 2019 05:01

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