International Journal of Epidemiology 2000;29:118-124
© International Epidemiological Association 2000
Social determinants of birthweight and length of gestation in Estonia during the transition to democracy
a European Centre on Health of Societies in Transition, London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, UK.
b Department of Epidemiology and Biostatistics, Institute of Experimental and Clinical Medicine, Hiiu 42, EE11619 Tallinn, Estonia.
c Women's Clinic, University of Tartu, Lossi 36, EE51003 Tartu, Estonia.
Reprint requests to: Dr Ilona Koupilova, European Centre on Health of Societies in Transition, London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, UK. E-mail: ilona.koupilova{at}lshtm.ac.uk
Background To investigate social variation in birthweight and length of gestation in Estonia in the period of transition to a democracy and market economy.
Methods All live births resulting from singleton pregnancies reported to the Estonian Medical Birth Registry in 1992–1997 (n = 84 629) were studied with respect to social variation in birthweight and preterm delivery (<37 weeks gestation). The results were adjusted for maternal age, parity, education, nationality, marital status, smoking in pregnancy, sex of the infant (and gestational age).
Results Between 1992 and 1997, mean birthweight increased from 3465 g to 3497 g (P < 0.001) and the preterm rate fell from 5.8% to 5.1% (P = 0.001). Maternal education, marital status and nationality were all independently related to the mean birthweight and the risk of preterm birth. The mean difference in birthweight between children of mothers with basic and university education was 87 g (95% CI : 74–100). Children born to mothers of non-Estonian compared to Estonian nationality were on average 77 g lighter (95% CI : 70–84). While the effect of nationality and marital status on birthweight was relatively stable during the study period, differences in birth outcome by maternal education became stronger.
Conclusions The mean birthweight increased and the preterm rate decreased in Estonia as a whole during the transition. However, the improvements were not shared equally by all social groups. An increase in variation in birthweight by maternal education was particularly notable.
Keywords Birthweight, preterm birth, socioeconomic factors, health inequalities, Estonia
Accepted 22 July 1999
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