Extreme maternal education and preterm birth: time-to-event analysis of age and nativity-dependent risks

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• 作者：Nathalie Auger ; MD ; MSc ; FRCPC^a ; ^b ; ^c ; ^{nathalie.auger@inspq.qc.ca} ; Michal Abrahamowicz ; PhD^d ; Alison L. Park ; MSc^a ; ^b ; Willy Wynant ; MSc^d
• 关键词：Educational status ; Gestational age ; Immigrants ; Age ; maternal ; Premature birth
• 刊名：Annals of Epidemiology
• 出版年：2013
• 出版时间：January, 2013
• 年：2013
• 卷：23
• 期：1
• 页码：1-6
• 全文大小：337 K

文摘

Purpose

Increasing numbers of women achieve extremely high education, but the association with preterm birth (PTB) is poorly understood, especially over the life course. We sought to determine how very high educational attainment is associated with PTB, and to assess differences by maternal age and nativity.

Methods

Data included singleton live births to mothers aged ¡Ý20 years in metropolitan areas of Qu¨¦bec, Canada, from 1995 to 2005 (n?= 537,525). Hazard ratios of PTB (<37 gestational weeks) were estimated over the continuous range of education (0-30 years) according to maternal age (20-24, 25-29, 30-34, ¡Ý35 years) and nativity in a flexible survival model.

Results

The relationship between education and PTB was not linear, but suggested that extremely high education was not as protective against PTB as slightly lower education. Education thresholds that offered maximum protection increased with maternal age, and were lower for Canadian-born (17-21 years of education) than foreign-born (22-25 years of education) mothers.

Conclusions

Extremely high education did not confer more protection against PTB than slightly lower education, and associations varied over the life course. The threshold number of years of education most protective against PTB: (1) increased with maternal age, especially for Canadian-born mothers, and (2) was higher for foreign-born mothers.