Neural tube defects: an analysis of neighbourhood‐ and individual‐level socio‐economic characteristics

Abstract

Summary Several studies have reported that neural tube defects (NTD) occur more frequently among children born to women of lower socio-economic status (SES). This study investigated the relationship between individual- and neighbourhood-level SES and the risk of an NTD-affected pregnancy. Data were drawn from a population-based case-control study of fetuses and infants among a cohort of California births between July 1999 and June 2003. Information on individual SES was obtained via telephone interviews with mothers of 337 (76% of eligible) cases and 626 (79% of eligible) non-malformed liveborn controls. Respondents’ addresses were linked to the 2000 US Census to characterise six measures of neighbourhood SES (education, poverty, unemployment, occupation, crowding and rental occupancy). The analyses indicated that relative to women with a high school education, those with less than a high school education had a 1.7-fold increased risk of delivering infants with NTDs [95% CI 1.2, 2.6]. Twofold elevated risks for NTDs were observed for women with less than a high school education who lived in neighbourhoods where a majority of residents had not graduated from high school [95% CI 1.3, 3.1]. No consistent risk gradients were observed between NTD-affected pregnancies and indicators of lower neighbourhood SES. Results for phenotype subgroups were similar to those for all cases. Low maternal education was associated with an elevated risk of NTD in offspring. This risk varied by the education profile of the neighbourhood: women who did not graduate from high school and lived in less educated neighbourhoods exhibited a higher risk.

Risk Factors Associated with Lipomyelomeningocele: A Case-Control Study

“…It has been reported that women who live in low-socioeconomic-status neighborhoods and did not graduate from high school have a significantly higher risk of spinal dysraphism during pregnancy than mothers with a high school or higher education who live in the same region [24]. Another study reported a similar association of maternal educational status and spinal dysraphism among Hispanic Americans [25].…”

Recommendations for folate intake in women: implications for public health strategies

“…A low level of maternal education 38 and food shortage 39 have been identified as possible risk factors for neural tube defects, in addition to the use of medications which interfere with the metabolism of folic acid (anti-epileptics, aspirin, methotrexate, sulfasalazine etc. ), hyperthermia, use of tobacco and excessive doses of vitamin A (> 15,000IU) during pregnancy 40 .…”

Adverse social determinants and risk for congenital anomalies

“…2 Different studies have studied familiar and regional adverse social determinants in relation to perinatal outcome, such as neonatal mortality, 3 low birth weight 4 and prematurity, 5 but not in relation to congenital anomalies. Among the few reported causes on this issue, a low maternal socioeconomic level (SEL) has been associated with a higher risk of having a newborn infant with cleft lip, 6,9 neural tube defects, 7 and heart diseases. 8,9 The etiology of poverty in relation to congenital anomalies is varied, indirect and non-specific, and includes environmental conditions (pollution, v i o l e n c e , s t r e s s , e t c . )…”