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Mediating Factors Between Parental Socioeconomic Status and Small for Gestational Age in Infants: Results from the Hokkaido Study on Environment and Children’s Health

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Abstract

Objectives

Previous studies indicated a significant association between small for gestational age (SGA) in infants and their parents' socioeconomic status (SES). Thus, this study aimed to examine if parental factors, such as maternal smoking, and the pre-pregnancy body mass index (BMI) could mediate the associations between parental SES and SGA.

Methods

The participants of this study were pregnant women who enrolled in an ongoing birth cohort study, the Hokkaido study, during the first trimester of their pregnancies. A total of 14,593 live singleton births were included in the statistical analysis, of which 1011 (6.9%) were SGA. Two structural equation models were employed to evaluate the associations between parental SES, parental characteristics, and SGA.

Results

The effect of low SES on SGA was directly mediated by maternal pre-pregnancy BMI, smoking during the third trimester, and alcohol consumption during the first trimester in the first model, which was based the assumption of independent associations between mediating factors. In the second model, which additionally considered the mediating factors from the first model, smoking during pregnancy mediated decline in parental SES, consequently increased SGA. Moreover, an increase in pregnancy smoking status increased the prevalence of lower maternal pre-pregnancy BMI and its effect on SGA.

Conclusions for Practice

In this study, we observed the independent mediating effect of maternal pre-pregnancy BMI, smoking, and alcohol consumption during pregnancy on low SES and, consequently, SGA, with the additional mediating pathway of SES to smoking to low BMI on SGA.

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References

  • Amorim, L. D., Fiaccone, R. L., Santos, C. A., Santos, T. N., Moraes, L. T., Oliveira, N., et al. (2010). Structural equation modeling in epidemiology. Cadernos de saúde pública, 26(12), 2251–2262.

    Article  Google Scholar 

  • Barker, D. J. P. (1995). Fetal origins of coronary heart disease. British Medical Journal, 311(6998), 171–174.

    Article  CAS  Google Scholar 

  • Blumenshine, P., Egerter, S., Barclay, C. J., Cubbin, C., & Braveman, P. A. (2010). Socioeconomic disparities in adverse birth outcomes: A systematic review. American Journal of Preventive Medicine, 39(3), 263–272.

    Article  Google Scholar 

  • Bonamy, A.-K.E., Norman, M., & Kaijser, M. (2008). Being born too small, too early, or both: Does it matter for risk of hypertension in the elderly? American Journal of Hypertension, 21(10), 1107–1110.

    Article  Google Scholar 

  • Boucher, J., & Konkle, A. T. (2016). Understanding inequalities of maternal smoking-bridging the gap with adapted intervention strategies. International Journal of Environmental Research and Public Health, 13(3), 282.

    Article  Google Scholar 

  • Bray, I., Gunnell, D., & Davey Smith, G. (2006). Advanced paternal age: How old is too old? Journal of Epidemiol Community Health, 60, 851–853.

    Article  Google Scholar 

  • Brink, L. T., Nel, D. G., Hall, D. R., & Odendaal, H. J. (2020). Association of socioeconomic status and clinical and demographic conditions with the prevalence of preterm birth. International Journal of Gynecology & Obstetrics, 149, 359–369.

    Article  Google Scholar 

  • Fujiwara, T., Ito, J., & Kawachi, I. (2013). Income inequality, parental socioeconomic status, and birth outcomes in Japan. American Journal of Epidemiology, 177(10), 1042–1052.

    Article  Google Scholar 

  • Galobardes, B., Shaw, M., Lawlor, D. A., Lynch, J. W., & Davey Smith, G. (2006). Indicators of socioeconomic position (part 1). Journal of Epidemiology and Community Health, 60(1), 7–12.

    Article  Google Scholar 

  • Gluckman, P. D., & Hanson, M. A. (2004). Developmental origins of disease paradigm: A mechanistic and evolutionary perspective. Pediatric Research, 56(3), 311–317.

    Article  Google Scholar 

  • Hanaoka, T., Tamura, N., Ito, K., Sasaki, S., Araki, A., Ikeno, T., et al. (2018). Prevalence and risk of birth defects observed in a prospective cohort study; the Hokkaido study on environment and children’s health. Journal of Epidemiology, 28(3), 125–132.

    Article  Google Scholar 

  • Heffner, L. J. (2004). Advanced maternal age—How old is too old? New England Journal of Medicine, 351, 1927–1929.

    Article  CAS  Google Scholar 

  • Heude, B., Thièbaugeorges, O., Goua, V., Forhan, A., Kaminski, M., et al. (2012). Pre-pregnancy body mass index and weight gain during pregnancy: Relations with gestational diabetes and hypertension, and birth outcomes. Maternal and Child Health Journal, 16, 355–363.

    Article  CAS  Google Scholar 

  • Hulley, S. B., Cummings, S. R., Browner, W. S., Grady, D. G., & Newman, T. B. (2014). Designing clinical research (4th edn.) [Japanese] (M. Kihara & M. Kihara, Trans.). Tokyo: Medical Sciences International, Ltd.

  • Itabashi, K., Miura, F., Uehara, R., & Nakamura, Y. (2014). New Japanese neonatal anthropometric charts for gestational age at birth. Pediatric International, 56(5), 702–708.

    Article  Google Scholar 

  • Itoh, H., Kohmura-Kobayashi, Y., Kawai, K., & Kanayama, N. (2018). Multiple causative factors underlie low birthweight [eLetters]. Sciences. Retrieved from https://science.sciencemag.org/content/361/6401/440/tab-e-letters.

  • Kishi, R., Araki, A., Minatoya, M., Hanaoka, T., Miyashita, C., Itoh, S., et al. (2017). The Hokkaido Birth Cohort Study on Environment and Children’s Health: Cohort profile—updated 2017. Environmental Health and Preventive Medicine, 22(1), 46.

    Article  Google Scholar 

  • Kishi, R., Kobayashi, S., Ikeno, T., Araki, A., Miyashita, C., Itoh, S., et al. (2013). Ten years of progress in the Hokkaido birth cohort study on environment and children’s health: Cohort profile—updated 2013. Environmental Health and Preventive Medicine, 18(6), 429–450.

    Article  Google Scholar 

  • Kishi, R., Sasaki, S., Yoshioka, E., Yuasa, M., Sata, F., Saijo, Y., et al. (2011). Cohort profile: The Hokkaido study on environment and children’s health in Japan. International Journal of Epidemiology, 40(3), 611–618.

    Article  Google Scholar 

  • Kobayashi, S., & Nishikawa, Y. (2010). The definition of people with low income in Japan: Validity of the criteria of “Persons Exempt from Municipal Taxes”-[Japanese]. Journal of Nagoya Bunri University, 10, 23–33.

    Google Scholar 

  • Kobayashi, S., Sata, F., Hanaoka, T., Braimoh, T., Ito, K., Tamura, N., et al. (2019). Association between maternal passive smoking and increased risk of delivering small-for-gestational-age infants at full-term using plasma cotinine levels from The Hokkaido Study: A prospective birth cohort. British Medical Journal Open, 9(2), e023200.

    Google Scholar 

  • Ludvigsson, J. F., Lu, D., Hammarström, L., Cnattingius, S., & Fang, F. (2018). Small for gestational age and risk of childhood mortality: A Swedish population study. PLOS Medicine, 15(12), e1002717.

    Article  Google Scholar 

  • Ministry of Health, Labour, and Welfare. (2016). Summary Report of Comprehensive Survey of Living Conditions 2016. Tokyo: Ministry of Health, Labour, and Welfare. Retrieved March 13, 2019 from https://www.mhlw.go.jp/english/database/db-hss/cslc-report2016.html.

  • 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.

    Article  Google Scholar 

  • Mother’s & Children’s Health Welfare Association. (2016). Maternal and child health statistics of Japan. Tokyo: Katsuya Kamiya.

    Google Scholar 

  • Normile, D. (2018). Staying slim during pregnancy carries a price. Science, 361(6401), 440.

    CAS  PubMed  Google Scholar 

  • Ogawa, K., Morisaki, N., Sago, H., Fujiwara, T., & Horikawa, R. (2018). Association between women’s perceived ideal gestational weight gain during pregnancy and pregnancy outcomes. Scientific Reports, 8, 11574.

    Article  Google Scholar 

  • Oshio, A. (2011). Psychological research data analysis by SPSS and Amos. [Japanese] (2nd ed.). Tokyo: TokyoTosho.

    Google Scholar 

  • Sasaki, S., Braimoh, T. S., Yila, T. A., Yoshioka, E., & Kishi, R. (2011). Self-reported tobacco smoke exposure and plasma cotinine levels during pregnancy—A validation study in Northern Japan. The Science of the Total Environment, 412–413, 114–118.

    Article  Google Scholar 

  • Shah, P. S., & Knowledge Synthesis Group on Determinants of LBW/PT births. (2010). Parity and low birth weight and preterm birth: A systematic review and meta-analyses. Acta Obstetricia et Gynecologica Scandinavica, 89(7), 862–875.

    Article  Google Scholar 

  • Streiner, D. L., Norman, G. R., & Cairney, J. (2016). Health Measurement Scales: A practical guide to their development and use (5th edn.) [Japanese] (M. Kihara, M. Kaji, & M. Kihara, Trans.). Tokyo: Medical Sciences International, Ltd.

  • Tairaku, S., Yamasaki, M., Makihara, N., Tanimura, K., Hazama, R., et al. (2012). A study of maternal progress during pregnancy complicated by chronic hypertension resulting in poor perinatal outcome. Advances in Obstetrics and Gynecology, 64, 17–22.

    Google Scholar 

  • Tamura, N., Hanaoka, T., Ito, K., Araki, A., Miyashita, C., Ito, S., et al. (2018). Different risk factors for very low birth weight, term-small-for-gestational-age, or preterm birth in Japan. International Journal of Environmental Research & Public Health, 15(2), 369.

    Article  Google Scholar 

  • Thévenon, O., Manfredi, T., Govind, Y., & Klauzner, I. (2018). Child poverty in the OECD. OECD Social, Employment, and Migration Working Papers. No. 218. Paris; Organisation for Economic Co-operation and Development. Retrieved from https://www.oecd-ilibrary.org/content/paper/c69de229-en.

  • Toyoda, H. (1998). Covariance structure analysis: structure equation modeling. Tokyo: AsakuraShoten.

    Google Scholar 

  • Toyoda, H. (2007). Covariance structure analysis: Structure equation modeling (Amos version). Tokyo: TokyoTosho.

    Google Scholar 

  • Travier, N., Agudo, A., May, A. M., Gonzalez, C., Luan, J., Besson, H., et al. (2009). Smoking and body fatness measurements: A cross-sectional analysis in the EPIC-PANACEA study. Preventive Medicine, 49(5), 365–373.

    Article  Google Scholar 

  • Tsukamoto, H., Fukuoka, H., Koyasu, M., Nagai, Y., & Takimoto, H. (2007). Risk factors for small for gestational age. Pediatric International, 49(6), 985–990.

    Article  Google Scholar 

  • Van Den Berg, G., Van Eijsden, M., Galindo-Garre, F., Vrijkotte, T., & Gemke, R. (2013). Low maternal education is associated with increased growth velocity in the first year of life and in early childhood: The ABCD study. European Journal of Pediatrics, 172(11), 1451–1457.

    Article  Google Scholar 

  • WHO Expert Consultation. (2004). Appropriate body-mass index for Asian populations and its implications for policy and intervention strategies. Lancet, 363(9403), 157–163.

    Article  Google Scholar 

  • Wolf, E. J., Harrington, K. M., Clark, S. L., & Miller, M. W. (2013). Sample size lrequirements for structural equation models: An evaluation of power, bias, and solution propriety. Educational and Psychological Measurement, 76(6), 913–934.

    Article  Google Scholar 

Download references

Acknowledgements

We thank the mothers and children who participated in this study, and all the staff at The Hokkaido Study on Environment and Child Health. We express our profound gratitude to all hospital and clinic personnel who collaborated with us during the study, including those from Keiai Hospital, Endo Kikyo Maternity Clinic, Shiroishi Hospital, Memuro Municipal Hospital, Aoba Ladies Clinic, Obihiro-Kyokai Hospital, Akiyama Memorial Hospital, Sapporo Medical University Hospital, Hokkaido University Hospital, Kitami Red Cross Hospital, Hoyukai Sapporo Hospital, Gorinbashi Hospital, Hashimoto Clinic, Asahikawa Medical College Hospital, Hakodate Central General Hospital, Ohji General Hospital, Nakashibetsu Municipal Hospital, Sapporo Tokushukai Hospital, Asahikawa Red Cross Hospital, Wakkanai City Hospital, Kushiro Rosai Hospital, Sapporo-Kosei General Hospital, Shibetsu City General Hospital, Nikko Memorial Hospital, Sapporo City General Hospital, Kohnan Hospital, Hakodate City Hospital, Hokkaido Monbetsu Hospital, Tenshi Hospital, Hakodate Goryoukaku Hospital, Nakamura Hospital, Kin-ikyo Sapporo Hospital, Kitami Lady’s Clinic, Engaru-Kosei General Hospital, Kushiro Red Cross Hospital, Nayoro City General Hospital, and Obihiro-Kosei General Hospital.

Funding

This study was funded by a Grant-in-Aid for Scientific Research from the Japanese Ministry of Health, Labour, and Welfare (H26-Kagaku Ippan-002, H29-Kagaku Ippan-002); the Ministry of Education, Culture, Sports, Science, and Technology; and the Japan Society for the Promotion of Science KAKENHI (JP19H01071, JP19K14169); AMED (JP20gk0110039).

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Authors and Affiliations

  1. Hokkaido University Center for Environmental and Health Sciences, Kita 12, Nishi 7, Kita-ku, Sapporo, Hokkaido, 060-0812, Japan

    Naomi Tamura, Tomoyuki Hanaoka, Kumiko Ito, Atsuko Araki, Chihiro Miyashita, Sachiko Ito, Sumitaka Kobayashi & Reiko Kishi

  2. Graduate School of Health Science, Hokkaido University, Sapporo, Japan

    Naomi Tamura & Atsuko Araki

  3. Research Center for Medical and Health Data Science, The Institute of Statistical Mathematics, Tokyo, Japan

    Naomi Tamura & Yoichi Ito

  4. Graduate School of Medicine, Hokkaido University, Sapporo, Japan

    Kumiko Ito

  5. Departments of Obstetrics and Gynecology, Graduate School of Medicine, Hokkaido University, Sapporo, Japan

    Hisanori Minakami & Kazutoshi Cho

  6. Departments of Obstetrics and Gynecology, School of Medicine, Sapporo Medical University, Sapporo, Japan

    Toshiaki Endo & Tsuyoshi Baba

  7. Departments of Obstetrics and Gynecology, Asahikawa Medical University, Asahikawa, Japan

    Kazuo Sengoku & Toshinobu Miyamoto

  8. Faculties of Health Science, Hokkaido University, Sapporo, Japan

    Katsuhiko Ogasawara

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  1. Naomi Tamura
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Correspondence to Reiko Kishi.

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Tamura, N., Hanaoka, T., Ito, K. et al. Mediating Factors Between Parental Socioeconomic Status and Small for Gestational Age in Infants: Results from the Hokkaido Study on Environment and Children’s Health. Matern Child Health J 25, 645–655 (2021). https://doi.org/10.1007/s10995-020-03035-w

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