This is the final version of the article. Available from BioMed Central via the DOI in this record.
Background: Cognitive development in childhood is negatively affected by socioeconomic
disadvantage. This study examined whether differences in fetal environment might mediate the
association between family socioeconomic position and child development.
Methods: Data were linked from the Scottish Longitudinal Study, maternity inpatient records and
the Child Health Surveillance Programme – Pre School for 32,238 children. The outcome variables
were based on health visitor assessment of gross motor, hearing and language, vision and fine
motor, and social development. Socioeconomic position was measured using parental social class
and highest qualification attained. Random-effects logistic regression models were estimated to
account for multiple reviews and familial clustering. Mediation analysis was conducted using the
Karlson-Holm-Breen method.
Results: Hearing and language, vision and fine motor, and social development were associated with
lower parental social class and lower parental educational qualifications after adjustment for fetal
environment. Fetal environment partially mediated the estimated effect of having parents without
educational qualifications for hearing and language (β = 0·15; 95% confidence interval (CI) = 0·07,
0·23), vision and fine motor (β = 0·19; CI = 0·10, 0·28) and social development (β = 0·14; CI = 0·03 to
0·25).
Conclusions: Socioeconomic position predicted hearing and language, vision and fine motor, and
social development but not gross motor development. For children of parents without educational
qualifications, fetal environment appears to contribute to a part of the socioeconomic gradient in
child development abnormalities but post-natal environment appears to still explain the majority of
the gradient and for other children most of it.
This work was supported by a grant from the Wellcome Trust (The Scottish Health
Informatics Programme-Ref WT086113) and the Economic and Social Research Council (grant
numbers ES/L007487/1 and ES/I025561/3). The LSCS is supported by the ESRC/JISC, the Scottish
Funding Council, the Chief Scientist’s Office and the Scottish Government.