SOCIOECONOMIC-STATUS, NEIGHBORHOOD SOCIAL CONDITIONS, AND NEURAL-TUBEDEFECTS

Objectives. This study evaluated the contributions of lower socioecono mic status (SES) and neighborhood socioeconomic characteristics to neu ral tube defect etiology. The influence of additional factors, includi ng periconceptional multivitamin use and race ethnicity, was also expl ored. Methods. Data derived from a case-control study of California pr egnancies from 1989 to 1991. Mothers of 538 (87.8% of eligible) case i nfants! fetuses with neural tube defects and mothers of 539 (88.2%) no nmalformed infants were interviewed about their SES. Reported addresse s were linked to 1990 US census information to characterize neighborho ods. Results Twofold elevated risks were observed for several SES indi cators. Risks were somewhat confounded by vitamin use, race/ethnicity, age, body mass index, and fever but remained elevated after adjustmen t. A risk gradient was seen with increasing number of lower SES indica tors. Women with 1 to 3 and 4 to 6 lower SES indicators had adjusted o dds ratios of 1.6 (1.1-2.2) and 3.2 (1.9-5.4), respectively, compared viith women with no lower SES indicators. Conclusions. Both lower SES and residence in a SES-lower neighborhood increased the risk of an neu ral tube defect-affected pregnancy, with risks increasing across a gra dient of SES indicators.