Socioeconomic status, neighborhood social conditions, and neural tube defects

Am J Public Health. 1998 Nov;88(11):1674-80. doi: 10.2105/ajph.88.11.1674.


Objectives: This study evaluated the contributions of lower socioeconomic status (SES) and neighborhood socioeconomic characteristics to neural tube defect etiology. The influence of additional factors, including periconceptional multivitamin use and race/ethnicity, was also explored.

Methods: Data derived from a case-control study of California pregnancies from 1989 to 1991. Mothers of 538 (87.8% of eligible) case infants/fetuses with neural tube defects and mothers of 539 (88.2%) nonmalformed infants were interviewed about their SES. Reported addresses were linked to 1990 US census information to characterize neighborhoods.

Results: Twofold elevated risks were observed for several SES indicators. Risks were somewhat confounded by vitamin use, race/ethnicity, age, body mass index, and fever but remained elevated after adjustment. A risk gradient was seen with increasing number of lower SES indicators. Women with 1 to 3 and 4 to 6 lower SES indicators had adjusted odds ratios of 1.6 (1.1-2.2) and 3.2 (1.9-5.4), respectively, compared with women with no lower SES indicators.

Conclusions: Both lower SES and residence in a SES-lower neighborhood increased the risk of an neural tube defect-affected pregnancy, with risks increasing across a gradient of SES indicators.

MeSH terms

  • Adult
  • California
  • Case-Control Studies
  • Female
  • Humans
  • Neural Tube Defects / etiology*
  • Nutritional Status
  • Odds Ratio
  • Poverty / statistics & numerical data*
  • Pregnancy
  • Racial Groups
  • Residence Characteristics / statistics & numerical data*
  • Risk Factors
  • Social Conditions / statistics & numerical data*
  • Surveys and Questionnaires