Maternal and Child Health Journal

, Volume 18, Issue 8, pp 1814–1822 | Cite as

Maternal Education and Perinatal Outcomes Among Spanish Women Residing in Southern Spain (2001–2011)

  • Sol Juárez
  • Bárbara A. Revuelta-Eugercios
  • Diego Ramiro-Fariñas
  • Francisco Viciana-Fernández
Article

Abstract

Evidence suggests that educational differences in perinatal outcomes have increased in some countries (Eastern Europe) while remained stable in others (Scandinavian countries). However, less is known about the experience of Southern Europe. This study aims to evaluate the association between maternal education and perinatal outcomes derived from birthweight (low birthweight and macrosomia) and gestational age (pre-term and post-term births) among Spaniards living in the Autonomous Community of Andalusia during the period 2001–2011 (around 19 % of births in Spain); and to evaluate whether the educational differences narrowed or widened during that period, which includes both an economic boom (2001–2008) and the global economic crisis (2009–2011). This study uses the Andalusian Population Longitudinal Database and the Vital Statistics Data provided by the Spanish National Statistics Institute. We study live and singleton births of Spanish mothers who lived in Andalusia at the time of delivery (n = 404,951). ORs with 95 % confidence intervals (crude and adjusted) were estimated using multinomial regression models. A negative educational gradient is observed in all perinatal outcomes studied (i.e., the higher the educational status, the lower the risk of negative perinatal outcomes). However, when disaggregating the sample in two periods, the gradient is only statistically significant for pre-term birth during 2001–2008, while a full gradient is observed in all perinatal indicators in the period 2009–2011 with an increase in the educational inequalities in macrosomia and post-term. Further studies are needed in order to confirm whether there is a causal association between the widening of the educational differences in perinatal outcomes and the onset of the economic crisis in Spain, or the widening can be explained by other factors, such as changes in childbearing patterns and the composition of women accessing motherhood.

Keywords

Birthweight Macrosomia Pre-term Post-term Spain 

Notes

Acknowledgments

This work was financially supported by the Spanish Ministry of Economy and Competitiveness (Grants CSO2010-11485-E and CSO2011-29970), the Centre for Economic Demography at Lund University and SIMSAM Early Life (Lund University).

Conflict of interest

The authors do not have any potential conflict of interest in relation to this work.

References

  1. 1.
    Barker, D. (2006). Birth weight and hypertension. Hypertension, 48, 357–358.PubMedCrossRefGoogle Scholar
  2. 2.
    Godfrey, K., & Barker, D. (2007). Fetal programming and adult health. Public Health Nutrition, 4(2B), 611–624.Google Scholar
  3. 3.
    Risner, K. R., Vatten, L. J., Barker, J. L., et al. (2011). Birthweight and mortality in adulthood: A systematic review and meta-analysis. International Journal of Epidemiology, 40(3), 647–661.CrossRefGoogle Scholar
  4. 4.
    Leon, D. A., Lithell, H. O., Vagero, D., et al. (1998). Reduced fetal growth rate and increased risk death from ischaemic heart disease: Cohort study of 15000 Swedish men and women born 1915–1929. BMJ, 317, 241–245.PubMedCrossRefPubMedCentralGoogle Scholar
  5. 5.
    Gillman, M. W. (2004). A life course approach to obesity. In K. Diana & Y. Ben-Shlomo (Eds.), A life course approach to chronic disease epidemiology. Oxford: Oxford University Press.Google Scholar
  6. 6.
    Coria-Soto, I. L., Bobadilla, J. L., & Notzon, F. (1996). The effectiveness of antenatal care in preventing intrauterine growth retardation and low birth weight due to preterm delivery. International Journal for Quality in Health Care, 8(1), 13–20.PubMedCrossRefGoogle Scholar
  7. 7.
    Kramer, M. S. (1987). Determinants of low birth weight: Methodological assessment and meta-analysis. Bulletin of the World Health Organization, 65(5), 663–737.PubMedPubMedCentralGoogle Scholar
  8. 8.
    Juárez, S., & Revuelta Eugercios, B. (2013). Socio-economic differences in low birth weight: Revisiting epidemiological approaches. REIS, 144, 73–96.Google Scholar
  9. 9.
    Rodríguez, C., Regidor, E., & Gutiérrez-Fisca, J. L. (1995). Low birth weight in Spain associated with sociodemographic factors. Journal of Epidemiology and Community Health, 49, 38–42.PubMedCrossRefPubMedCentralGoogle Scholar
  10. 10.
    Kramer, M. S., Seguin, L., Lydon, J., & Goulet, L. (2000). Socio-economic disparities in pregnancy outcome: Why do the poor fare so poorly? Paediatric and Perinatal Epidemiology, 14, 194–210.PubMedCrossRefGoogle Scholar
  11. 11.
    Caldwell, J. C. (1979). Education as a factor in mortality decline. An examination of Nigerian data. Population Studies, 33(3), 395–413.CrossRefGoogle Scholar
  12. 12.
    Ross, C., & Mirowsky, J. (1999). Refining the association between education and health: The effects of quantity, credential, and selectivity. Demography, 19, 445–460.CrossRefGoogle Scholar
  13. 13.
    Villalbí, J. R., Salvador, J., Cano-Serral, G., Rodríguez-Sanz, M., & Borrell, C. (2007). Maternal smoking, social class and outcomes of pregnancy. Paediatric and Perinatal Epidemiology, 21, 441–447.PubMedCrossRefGoogle Scholar
  14. 14.
    Torrent, M., Sunyer, J., Cullinan, P., et al. (2004). Smoking cessation and associated factors during pregnancy. Gaceta Sanitaria, 18(3), 184–189.PubMedCrossRefGoogle Scholar
  15. 15.
    Brzezinski, Z., & Szamotulska, K. (1994). The widening gap in low birthweight rates between extreme social groups in Poland during 1985–1990. Paediatric and Perinatal Epidemiology, 8(1), 373–383.PubMedCrossRefGoogle Scholar
  16. 16.
    Koupilova, I., Bobak, M., Holcik, J., Pikhart, H., & Leon, D. (1998). Increasing social variation in birth outcomes in the Czech Republic after 1989. American Journal of Public Health, 88(9), 1343–1347.PubMedCrossRefPubMedCentralGoogle Scholar
  17. 17.
    Koupilova, I., Rahu, K., Rahu, B., Karro, M. B., & Leon, D. (2000). Social determinants of birthweight and length of gestation in Estonia during the transition to democracy. International Journal of Epidemiology, 29(1), 118–124.PubMedCrossRefGoogle Scholar
  18. 18.
    Mortensen, L. H., Diderichsen, F., Arntzen, A., et al. (2008). Social inequality in fetal growth: A comparative study of Denmark, Finland, Norway and Sweden in the period 1981–2000. Journal of Epidemiology and Community Health, 62(4), 325–331.PubMedCrossRefGoogle Scholar
  19. 19.
    Ronda, E., Hernández-Mora, A., García, A. M., & Regidor, E. (2009). Ocupación materna, duración delagestación y bajo peso al nacimiento. Gaceta Sanitaria, 23(3), 179–185.PubMedCrossRefGoogle Scholar
  20. 20.
    Speciale, A. M., & Regidor, E. (2011). Understanding the universality of the immigrant health paradox: The Spanish perspective. Journal of Immigrant Minority Health, 13, 518–525.PubMedCrossRefGoogle Scholar
  21. 21.
    Castro Martín, T. (2010). Single motherhood and birthweight is Spain: Narrowing social inequalities in health? Demographic Research, 22, 863–890.CrossRefGoogle Scholar
  22. 22.
    Merlo, J., Viciana-Fernández, F., & Ramiro Fariñas, D. (2012). Bringing the individual back to small-area variation studies: A multilevel analysis of all-cause mortality in Andalusia, Spain. Social Science and Medicine, 75(8), 1477–1487.PubMedCrossRefGoogle Scholar
  23. 23.
    Cunningham, F. G. (2005). Williams obstetrics (3rd ed.). New York: McGraw-Hill.Google Scholar
  24. 24.
    Baylos Trillo, A., Trillo Párraga, F. (2012). The impact of anti-crisis measures and the social and employment situation in Spain: The Workers’ Group of the European Economic and Social Committee.Google Scholar
  25. 25.
    Cutler, D., & Lleras-Muney, A. (2010). Understanding differences in health behaviors by education. Journal of Health Economics, 29(1), 1–28.PubMedCrossRefPubMedCentralGoogle Scholar
  26. 26.
    Lynch, J., & Kaplan, G. (2000). Socioeconomic position. In L. F. Berkman & I. Kawachi (Eds.), Social epidemiology (pp. 13–35). Oxford: Oxford University Press.Google Scholar
  27. 27.
    Jansen, P. W., Tiemeier, H., Looman, C. W. N., et al. (2009). Explaining educational inequalities in birthweight: The generation R study. Pediatrics and Perinatal Epidemiology, 23, 216–228.CrossRefGoogle Scholar
  28. 28.
    Savitz, D. A., Harmon, Q., Siega-Riz, A. M., Herring, A. H., Dole, N., & Thorp, J. J. M. (2012). Behavioral influences on preterm birth: Integrated analysis of the pregnancy, infection, and nutrition study. Maternal and Child Health Journal, 6, 1151–1163.CrossRefGoogle Scholar
  29. 29.
    Caughey, A. B., Stotland, N. E., Washington, E., & Escobar, G. J. (2009). Who is at risk for prolonged and postterm pregnancy? American Journal of Obstetrics and Gynecology, 200, 683.e1–683.e5.CrossRefGoogle Scholar
  30. 30.
    Oberg, A. S., Frisell, T., Svensson, A. C., & Iliadou, A. N. (2013). Maternal and fetal genetic contributions to postterm birth: Familial clustering in a population-based sample of 475,429 Swedish births. American Journal of Epidemiology, 177(6), 531–537.Google Scholar
  31. 31.
    Campbell, M. K., Ostbye, T., & Irgens, L. (1997). Post-term birth: Risk factors and outcomes in a 10-years cohort of Norwegian births. Obstetrics and Gynecology, 89(4), 543–548.PubMedCrossRefGoogle Scholar
  32. 32.
    Voldner, N., Froslie, K., Bo, K., et al. (2008). Modifiable determinants of fetal macrosomia: Role of lifestyle-related factors. Acta Obstetricia et Gynecologica Scandinavica, 87(4), 423–429.PubMedCrossRefGoogle Scholar
  33. 33.
    Bergmann, R. L., Richter, R., Bergmann, K. E., Plagemann, A., Brauer, M., & Dudenhausen, J. W. (2003). Secular trends in neonatal macrosomia in Berlin: Influences of potential determinants. Pediatrics and Perinatal Epidemiology, 17, 244–249.CrossRefGoogle Scholar
  34. 34.
    Juárez, S., Alonso Ortíz, T., Ramiro Fariñas, D., & Bolúmar, F. (2012). The quality of vital statistics for studying perinatal health: The Spanish case. Paediatrics and Perinatal Epidemiology, 26(4), 310–315.CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2013

Authors and Affiliations

  • Sol Juárez
    • 1
  • Bárbara A. Revuelta-Eugercios
    • 1
  • Diego Ramiro-Fariñas
    • 2
  • Francisco Viciana-Fernández
    • 3
  1. 1.Centre for Economic DemographyLund UniversityLundSweden
  2. 2.Institute for Economics, Geography and DemographySpanish Council for Scientific ResearchMadridSpain
  3. 3.Institute of Statistics and Cartography of AndalusiaSevilleSpain

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