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Maternal educational level and risk of gestational hypertension: the Generation R Study

Journal of Human Hypertension volume 22, pages 483–492 (2008)Cite this article

Abstract

We examined whether maternal educational level as an indicator of socioeconomic status is associated with gestational hypertension. We also examined the extent to which the effect of education is mediated by maternal substance use (that is smoking, alcohol consumption and illegal drug use), pre-existing diabetes, anthropometrics (that is height and body mass index (BMI)) and blood pressure at enrolment. This was studied in 3262 Dutch pregnant women participating in the Generation R Study, a population-based cohort study. Level of maternal education was established by questionnaire at enrolment, and categorized into high, mid-high, mid-low and low. Diagnosis of gestational hypertension was retrieved from medical records using standard criteria. Odds ratios (OR) of gestational hypertension for educational levels were calculated, adjusted for potential confounders and additionally adjusted for potential mediators. Adjusted for age and gravidity, women with mid-low (OR: 1.52; 95% CI: 1.02, 2.27) and low education (OR: 1.30; 95% CI: 0.80, 2.12) had a higher risk of gestational hypertension than women with high education. Additional adjustment for substance use, pre-existing diabetes, anthropometrics and blood pressure at enrolment attenuated these ORs to 1.09 (95% CI: 0.70, 1.69) and 0.89 (95% CI: 0.50, 1.58), respectively. These attenuations were largely due to the effects of BMI and blood pressure at enrolment. Women with relatively low educational levels have a higher risk of gestational hypertension, which is largely due to higher BMI and blood pressure levels from early pregnancy. The higher risk of gestational hypertension in these women is probably caused by pre-existing hypertensive tendencies that manifested themselves during pregnancy.

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Acknowledgements

The Generation R Study is conducted by Erasmus MC, University Medical Centre Rotterdam in close collaboration with the Erasmus University Rotterdam School of Law and Faculty of Social Sciences, the Municipal Health Service for the Rotterdam area, the Rotterdam Homecare Foundation, Rotterdam and the Stichting Trombosedienst & Artsenlaboratorium Rijnmond (STAR), Rotterdam. We gratefully acknowledge the contribution of general practitioners, hospitals, midwives and pharmacies in Rotterdam. The first phase of the Generation R Study was made possible by financial support from Erasmus MC, University Medical Centre Rotterdam, Erasmus University Rotterdam and the Netherlands Organization for Health Research and Development (ZonMw). The present study was supported by an additional grant from the Netherlands Organization for Scientific Research (NWO, grant no 017.002.107).

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Authors and Affiliations

  1. The Generation R Study Group, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, The Netherlands

    L M Silva, M Coolman & V W V Jaddoe

  2. Department of Public Health, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, The Netherlands

    L M Silva, J P Mackenbach & H Raat

  3. Department of Obstetrics and Gynaecology, Division of Obstetrics and Prenatal Medicine, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, The Netherlands

    M Coolman & E A P Steegers

  4. Department of Epidemiology, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, The Netherlands

    V W V Jaddoe & A Hofman

  5. Department of Paediatrics, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, The Netherlands

    V W V Jaddoe & H A Moll

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  1. L M Silva
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Correspondence to L M Silva.

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Silva, L., Coolman, M., Steegers, E. et al. Maternal educational level and risk of gestational hypertension: the Generation R Study. J Hum Hypertens 22, 483–492 (2008). https://doi.org/10.1038/jhh.2008.22

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