International Journal of Epidemiology 2001;30:81-87
© International Epidemiological Association 2001
Special Theme: Fetal Origins of Health and Disease |
The impact of maternal education on intrauterine growth: a comparison of former West and East Germany
a Department of Epidemiology, Social Medicine and Health System Research, Hanover Medical School, Hanover, Germany.
b Department of Perinatology, Isala Clinics, Zwolle, The Netherlands.
c Clara Angela Foundation, Witten, Germany.
Elke Raum, Department of Epidemiology, Social Medicine and Health System Research, OE 5410, Hanover Medical School, 30623 Hanover, Germany. E-mail: raum{at}epi.mh-hannover.de
Abstract
Background Objective of this re-analysis of datasets from former East and West Germany was to examine the influence of maternal education on intrauterine growth in two different political and social systems.
Methods Information on socio-demographic or lifestyle factors and pregnancy outcome was available for 3374 liveborn singletons from West Germany (1987/88) and 3070 from East Germany (1990/91). Multiple logistic regression was used to estimate the association between maternal education and the risk of delivering a small-for-gestational-age (SGA) newborn below the 10th percentile of birthweight.
Results Women with the lowest education had a significantly elevated risk of SGA newborns compared to women with the highest education in West (odds ratio [OR] = 2.58, 95% CI : 1.17–5.67) and East Germany (OR = 2.77, 95% CI : 1.54– 5.00). The distribution of factors known to influence intrauterine growth varied with education in both states. After adjusting for these factors, women with the lowest educational level still had a higher risk of SGA birth: OR (West) = 2.02, 95% CI : 0.87–4.72; OR (East) = 1.95, 95% CI : 1.02–3.74.
Conclusions Our findings support the assumption that in former socialist countries health inequalities as a result of social inequalities existed.
KEY MESSAGES
- In both former German states which had different political, social and health care systems, the risk of delivering a small-for-gestational-age infant was higher for less educated women than for women with higher education.
- Maternal education reflected a certain constellation of influencing factors which were unique for particular educational levels and stood for better selfcare, better use of the health care system and better knowledge of health-related behaviour.
- Adjustment for these factors reduced the magnitude of the observed association somewhat, but could not fully explain the impact of maternal education.
Keywords Germany, epidemiology, educational status, pregnancy outcome, infant, low birthweight
Accepted 30 August 2000
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