Low socioeconomic status is a risk factor for preeclampsia: ... : Journal of Hypertension (original) (raw)

Original papers: Pre-eclampsia

Low socioeconomic status is a risk factor for preeclampsia: the Generation R Study

Silva, Lindsay Ma,b; Coolman, Mariannea,c; Steegers, Eric APc; Jaddoe, Vincent WVa,d,e; Moll, Henriëtte Ae; Hofman, Albertd; Mackenbach, Johan Pb; Raat, Heinb

aThe Generation R Study Group, the Netherlands

bDepartment of Public Health, the Netherlands

cDepartment of Obstetrics and Gynecology, Division of Obstetrics and Prenatal Medicine, the Netherlands

dDepartment of Epidemiology & Biostatistics, the Netherlands

eDepartment of Pediatrics, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, the Netherlands

Received 13 September, 2007

Revised 14 January, 2008

Accepted 13 February, 2008

Correspondence to Lindsay M. Silva, MD, The Generation R Study Group, Erasmus MC, University Medical Centre Rotterdam. PO BOX 2040, 3000 CA, Rotterdam, The Netherlands Tel: +31 10 7043405; fax: +31 10 7044645; e-mail: [email protected]

Abstract

Objectives

To examine whether maternal socioeconomic status, as indicated by maternal educational level, is associated with preeclampsia, and if so, to what extent known risk factors for preeclampsia mediate the effect of educational level.

Methods

In the Generation R Study, a population-based cohort study, we examined data of 3547 pregnant women. Odds ratios of preeclampsia for low, mid-low and mid-high educational level compared with high educational level were calculated after adjustment for confounders and additional adjustment for a selection of potential mediators (family history, material factors, psychosocial factors, substance use, working conditions, preexisting medical conditions, maternal anthropometrics and blood pressure at enrolment) that individually caused more than 10% change in the odds ratio for low education.

Results

Adjusted for the confounding effects of age, gravidity and multiple pregnancy, women with low educational level were more likely to develop preeclampsia (odds ratio 5.12; 95% confidence interval: 2.20, 11.93) than women with high educational level. After additional adjustment for financial difficulties, smoking in pregnancy, working conditions, body mass index and blood pressure at enrolment, the odds ratio was 4.91 (95% confidence interval: 1.93, 12.52).

Conclusion

Low maternal socioeconomic status is a strong risk factor for preeclampsia. Only a small part of this association can be explained by the mediating effects of established risk factors for preeclampsia. Further research is needed to disentangle the pathway from low socioeconomic status to preeclampsia.