Intergenerational Change in Maternal Education and Risk of Preterm Birth and Small-For-Gestational Age in White Non-Hispanic, Black Non-Hispanic and Hispanic Women in New Jerse

Aims.;In this thesis we examine the effect of grandmother's education on the risk of preterm birth (PTB) and small-for-gestational (SGA) in her grandchildren after accounting for mother's education.;Background.;Maternal lifelong socioeconomic status (SES) is believed to affect reproductive health. There are many studies that have shown strong association of mother's current SES with adverse birth outcomes. However, few studies have investigated associations with mother's childhood SES or grandparents' education. In U.S. blacks, previous data suggest that improvement in SES from childhood to adulthood is associated with improved social and mental health outcomes, but perinatal outcomes have rarely been assessed.;Methods.;We created a transgenerational dataset to examine the effect of grandmother's education, a dimension of SES, on risk of PTB and SGA in grandchildren. Using Link King Software we matched female infants listed on NJ birth certificates in 1979-1983 to mothers listed on NJ birth certificates for the years 1999-2011. Thus grandmothers were the women delivering in 1979-1983, and mothers were those born to the grandmothers who in turn delivered grandchildren in 1999-2011. We performed descriptive tabulations and multivariate logistic regression to create risk estimates using Statistical Analysis System (SAS) software.;Results.;In total we linked 107,347 grandmother and mother pairs. After exclusions (multiple births, gestational age of less than 20 weeks and greater than 47 weeks and other races) there were 99,463 pairs available for analysis. Overall, maternal education was associated inversely with PTB and SGA births in each of the largest demographic groups (non-Hispanic whites and blacks and Hispanics). There was a substantial inter-generational increase in education between grandmothers and mothers in each group, but it was most striking in Hispanics. SGA was more common in 1979-83 births than in 1999-2011. After adjusting for potential confounders, grandmother's education was as strongly associated with PTB of grandchildren as was mother's education. SGA in grandchildren was more common among low-education mothers, but grandmother's education had little effect. Although the overall SGA rates were higher in blacks and Hispanics as compared to whites, the effect of lower maternal education on risk of SGA was strongest in whites, and after adjusting for confounders it lost significance in blacks and Hispanics especially in the 1999-2011 births. Father's education was inversely related to PTB and SGA in all three ethnic groups and across both generations.;Conclusions.;In summary, we found that maternal education was an important predictor of PTB and SGA both in 1979-82 and in 1999-2011. Grandmother's education was as strong a predictor of PTB in grandchildren as mothers. However, grandmother's education was not strongly related to SGA in the grandchildren. Our results suggest that mother's childhood and preconception socioeconomic environment, including the educational level of her childhood household, are independent predictors for delivering preterm, but have less effect on intra-uterine growth.