Advertisement

Educational Attainment and Pregnancy Outcomes: A Danish Register-Based Study of the Influence of Childhood Social Disadvantage on Later Socioeconomic Disparities in Induced Abortion, Spontaneous Abortion, Stillbirth and Preterm Delivery

  • Emilie Rune HegelundEmail author
  • Gry Juul Poulsen
  • Laust Hvas Mortensen
Article
  • 25 Downloads

Abstract

Objectives Socioeconomic disparities in pregnancy outcomes have been found across times and places, but there is a lack of studies investigating the underlying causes. The present study investigated the influence of child protective services in the pregnant woman’s family of origin as a proxy of childhood social disadvantage. Methods The study population comprised all registered pregnancies in Denmark during the period from 2000 to 2009 that resulted in an induced abortion, spontaneous abortion, stillbirth or live birth (N = 786,054). Linear regression was used to analyze the associations between educational attainment and pregnancy outcomes in models with and without adjustment for age, parental educational attainment and child protective services in the family of origin. Further, it was tested whether child protective services in the pregnant woman’s family of origin modified the associations between educational attainment and pregnancy outcomes. Results Women with low educational attainment had a higher risk of induced abortion, stillbirth and preterm delivery and a lower risk of spontaneous abortion. These associations were to some extent explained by child protective services in the family of origin. Further, child protective services in the pregnant woman’s family of origin modified the association between educational attainment and risk of preterm delivery. Thus, women with high educational attainment were not found to differ in risk of preterm delivery according to child protective services in the family of origin Conclusions for Practice Information on childhood social disadvantage may enrich our understanding of the socioeconomic disparities in pregnancy outcomes

Keywords

Educational attainment Childhood social disadvantage Abortion Stillbirth Preterm delivery 

Notes

Acknowledgements

The authors want to thank Jenny Torssander for comments on an earlier draft of the manuscript.

Compliance with Ethical Standards

Conflict of interest

The authors declare that they have no conflict of interest.

Supplementary material

10995_2018_2704_MOESM1_ESM.docx (26 kb)
Supplementary material 1 (DOCX 25 KB)

References

  1. Alexander, G. R., Himes, J. H., Kaufman, R. B., Mor, J., & Kogan, M. (1996). A United States national reference for fetal growth. Obstetrics and Gynecology, 87(2), 163–168.CrossRefGoogle Scholar
  2. Brøndum, B. (2018). Hvordan går det udsatte børn og unge? [How are disadvantaged children and young people doing?]. Copenhagen: Statistics Denmark.Google Scholar
  3. Conley, D., Strully, K. W., & Bennett, N. G. (2003). The starting gate: Birth weight and life chances. Oakland: University of California Press.Google Scholar
  4. Currie, J., & Moretti, E. (2005). Biology as destiny? Short and long-run determinants of intergenerational transmission of birth weight. Cambridge: National Bureau of Economic Research.CrossRefGoogle Scholar
  5. Gilbert, N. (2012). A comparative study of child welfare systems: Abstract orientations and concrete results. Children and Youth Services Review, 34(3), 532–536.CrossRefGoogle Scholar
  6. Gilman, S. E., Martin, L. T., Abrams, D. B., Kawachi, I., Kubzansky, L., Loucks, E. B., … Buka, S. L. (2008). Educational attainment and cigarette smoking: A causal association? International Journal of Epidemiology, 37(3), 615–624.CrossRefGoogle Scholar
  7. Gluckman, P. D., Hanson, M. A., Bateson, P., Beedle, A. S., Law, C. M., Bhutta, Z. A., … West-Eberhard, M. J. (2009). Towards a new developmental synthesis: Adaptive developmental plasticity and human disease. The Lancet, 373(9675), 1654–1657.CrossRefGoogle Scholar
  8. Hansen, B. H. (2015). Analyse af udvikling i voksenlivet blandt tidligere anbragte børn. København: KL.Google Scholar
  9. Hertzman, C. (1999). The biological embedding of early experience and its effects on health in adulthood. Annals of the New York Academy of Sciences, 896, 85–95.CrossRefGoogle Scholar
  10. Kramer, M. S., Séguin, L., Lydon, J., & Goulet, L. (2000). Socio-economic disparities in pregnancy outcome: Why do the poor fare so poorly? Paediatric and Perinatal Epidemiology, 14(3), 194–210.CrossRefGoogle Scholar
  11. Lawlor, D. A., Mortensen, L., & Nybo Andersen, A.-M. (2011). Mechanisms underlying the associations of maternal age with adverse perinatal outcomes: A sibling study of 264,695 Danish women and their firstborn offspring. International Journal of Epidemiology, 40(5), 1205–1214.CrossRefGoogle Scholar
  12. Machin, S. (2006). Social disadvantage and education experiences. Paris: OECD.Google Scholar
  13. Mortensen, L. H. (2013). Socioeconomic inequality in birth weight and gestational age in Denmark 1996–2007: Using a family-based approach to explore alternative explanations. Social Science & Medicine, 76(1), 1–7.CrossRefGoogle Scholar
  14. Mortensen, L. H., Helweg-Larsen, K., & Andersen, A.-M. N. (2011). Socioeconomic differences in perinatal health and disease. Scandinavian Journal of Public Health, 39(7 Suppl), 110–114.CrossRefGoogle Scholar
  15. Mortensen, L. H., Maier, A. B., Slagbom, P. E., Pawelec, G., Derhovanessian, E., Petersen, I., … Christensen, K. (2012). Early-life environment influencing susceptibility to cytomegalovirus infection: evidence from the Leiden Longevity Study and the Longitudinal Study of Aging Danish Twins. Epidemiology and Infection, 140(5), 835–841.CrossRefGoogle Scholar
  16. Norsker, F. N., Espenhain, L., Rogvi, S. Á, Morgen, C. S., Andersen, P. K., & Andersen, A.-M. N. (2012). Socioeconomic position and the risk of spontaneous abortion: a study within the Danish National Birth Cohort. BMJ Open, 2(3), e001077.CrossRefGoogle Scholar
  17. Poulsen, G., Strandberg-Larsen, K., Mortensen, L., Barros, H., Cordier, S., Correia, S., … Andersen, A.-M. N. (2015). Exploring educational disparities in risk of preterm delivery: a comparative study of 12 European birth cohorts. Paediatric and Perinatal Epidemiology, 29(3), 172–183.CrossRefGoogle Scholar
  18. Rasch, V., Gammeltoft, T., Knudsen, L. B., Tobiassen, C., Ginzel, A., & Kempf, L. (2008). Induced abortion in Denmark: Effect of socio-economic situation and country of birth. European Journal of Public Health, 18(2), 144–149.CrossRefGoogle Scholar
  19. Statistics Denmark. (2017). Children and young people receiving social benefits. Retrieved March 27, 2017, from http://www.dst.dk/en/Statistik/dokumentation/documentationofstatistics/children-and-young-people-receiving-social-benefits.
  20. Statistics Denmark. (2018). Living conditions. Retrieved August 8, 2018, from http://statbank.dk/10046.
  21. Ubbesen, M. B. (2013). The Danish child protection system in light of register-based research. Aarhus: Aarhus University.Google Scholar
  22. Väisänen, H. (2015). The association between education and induced abortion for three cohorts of adults in Finland. Population Studies, 69(3), 373–388.CrossRefGoogle Scholar
  23. Zeitlin, J., Mortensen, L., Prunet, C., Macfarlane, A., Hindori-Mohangoo, A. D., Gissler, M., … Alexander, S. (2016). Socioeconomic inequalities in stillbirth rates in Europe: Measuring the gap using routine data from the Euro-Peristat project. BMC Pregnancy and Childbirth, 16, 15.CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Department of Public HealthUniversity of CopenhagenCopenhagen KDenmark

Personalised recommendations