Association between social position and congenital anomalies: A population-based study among 19,874 Danish women

Abstract

Aims: To examine the association between maternal and paternal educational level and household income and the risk of giving birth to a baby with a congenital anomaly in a population of Danish women. Methods: We performed a population-based cohort study, based on record linkage of data from Danish administrative registries. For each pregnant woman in the cohort, we described financial and educational resources and congenital anomalies in her offspring. We used logistic regression to model the association between social position and congenital anomalies. Results: The analyses included all 19,874 primiparous singleton deliveries in North Jutland county, Denmark, from 1991 to 1998. There were 1025 (5.2%) babies with congenital anomalies. The odds ratios (ORs) for giving birth to a baby with a congenital anomaly showed a dose— response decline, as the mothers' educational level increased. Women with less than 10 years of schooling had an almost three-fold increased risk of giving birth to an infant with a congenital anomaly, as compared with women with more than 4 years of higher education (OR=2.9, 95% confidence interval = 1.8—4.6). Paternal educational level and household income were, to a lesser degree, associated with congenital anomalies in the offspring. Conclusions: Maternal educational level, and to a lesser degree paternal educational level and household income, were associated with the risk of giving birth to a baby with a congenital anomaly. However, the analysis did not take into account maternal health status, and the results might be due to differential misclassification or residual confounding.

Keywords

Congenital anomalies maternal education social position

Get full access to this article

View all access options for this article.

References

Carmichael SL , Nelson V. , Shaw GM , Wasserman CR , Croen LA Socio-economic status and risk of conotruncal heart defects and orofacial clefts. Paediatr Perinatal Epidemiol 2003;17:264-71.

Wasserman CR , Shaw GM , Selvin S. , Gould JB , Syme LS Socioeconomic status, neighborhood social conditions, and neural tube defects. Am J Public Health 1998;88: 1674-80.

Olsen J. , Frische G. Social differences in reproductive health. Scand J Soc Med 1993;21:90-7.

Silva Costa CM , Gama SG , Carmo Leal M. Congenital malformations in Rio de Janeiro, Brazil: prevalence and associated factors. Cad Saúde Pública Rio de Janeiro 2006;22:2423-31.

Farley TF , Hambidge SJ , Daley MF Association of low maternal education with neural tube defects in Colorado, 1989-1998. Public Health 2002;116:89-94.

Medveczky E. , Puho E. Parental employment status and neural-tube defects and folic acid/multivitamin supplementation in Hungary . Eur J Obstet Gynecol Reprod Biol 2004;115:178-84.

Laumon B. , Martin JL , Collet P. , Bertucat I. , Verney MP , Robert E. Exposure to organic solvents during pregnancy and oral clefts: a case-control study. Reprod Toxicol 1996;10:15-19.

Lieff S. , Olshan AF , Werler M. , Strauss RP , Smith J. , Mitchell A. Maternal cigarette smoking during pregnancy and risk of oral clefts in newborns . Am J Epidemiol 1999;150:683-94.

Munger RG , Romitti PA , Daack-Hirsch S. , Burns TL , Murray JC , Hanson J. Maternal alcohol use and risk of orofacial cleft birth defects. Teratology 1996;54:27-33.

10.

Knudsen LB , Olsen J. The Danish Medical Birth Registry . Dan Med Bull 1998;45:320-3.

11.

National Statistical Office of Denmark. IDA - en integreret database for arbejdsmarkedsforskning. Catalog . Copenhagen: National Statistical Office of Denmark ; 1991.

12.

Canfield MA , Annegers JF , Brender JD , Cooper SP , Greenberg E. Hispanic origin and neural tube defects in Houston/Harris County, Texas. II: Risk factors . Am J Epidemiol 1996;143:12-24.

13.

Vrijheid M. , Dolk H. , Stone D. , Abramsky L. , Alberman E. , Scott JE Socioeconomic inequalities in risk of congenital anomaly. Arch Dis Child 2000;82:349-52.

14.

Kallen K. Maternal smoking and orofacial clefts. Cleft Palate Craniofac J 1997;34:11-16.

15.

Botto LD , Khoury MJ , Mulinare J. , Erickson JD Periconceptional multivitamin use and the occurrence of conotruncal heart defects: results from a population-based case-control study. Pediatrics 1996;98:911-17.

16.

Correa-Villasenor A. , McCarter R. , Downing J. , Ferencz C. the Baltimore-Washington Infant Study Group. White- black differences in cardiovascular malformations in infancy and socioeconomic factors. Am J Epidemiol 1991;134: 393-402.

17.

Lovett AA , Gatrell AC , Bound JP , Harvey PW , Whelan AF Congenital malformations in the Fylde region of Lancashire, England 1957-73. Soc Sci Med 1990;30:103-9.

18.

Loffredo CA , Silbergeld EK , Ferencz C. , Zhang J. Association of transposition of the great arteries in infants with maternal exposures to herbicides and rodenticides . Am J Epidemiol 2001;153:529-36.

19.

Croen LA , Shaw M. , Sanbonmatsu L. , Selvin S. , Buffler AP Maternal residential proximity to hazardous waste sites and risk for selected congenital malformations. Epidemiology 1997 ;8:347-55.

20.

Shaw GM , Carmichael SL , Laurent C. , Rasmussen SA Maternal nutrient intakes and risk of orofacial clefts. Epidemiology 2006;17:285-91.

21.

Shaw GM , Lammer EJ Maternal periconceptional alcohol consumption and risk for orofacial clefts . J Pediatr 1999;134: 298-303.

22.

Morales-Suárez-Varela MM , Bille C. , Christensen K. , Olsen J. Smoking habits, nicotine use, and congential malformations. Obstet Gynecol 2006;107:51-7.

23.

van der Pal-de Bruin KM , de Walle HE , de Rover CM , Jeeninga W. , Cornel MC , de Jong-van den Berg LT , Buitendijk SE , Paulssen TG Influence of educational level on determinants of folic acid use. Paediatr Perinat Epidemiol 2003;17:256-63.