B. Robustness checks
5. Conclusion
This paper uses high-quality data from Denmark to estimate the effects of maternal prenatal health behaviors on birth outcomes. My results not only are in line with earlier sibling-based studies on maternal prenatal smoking but also add to them by factoring in information on important maternal behaviors such as prenatal alcohol consumption.
I find that the negative smoking effect on birth weight and fetal growth is smaller than that suggested by cross-sectional analyses but remains rather stable in FE models in spite of inclusion of additional covariates. Exploiting sibling variation, I find that smoking reduces birth weight by 97g and fetal growth by 2.66g/week. When taking a mother FE and a number of maternal life styles into consideration, I find no significant smoking effects for the probability of experiencing a preterm birth. Maternal alcohol consumption in particular plays an important role, as it increaser the risk of preterm birth significantly by 7.8 percent for the number of units consumed per day (i.e., at the average of 0.28 units, an increase of 2.1 percent). I find that maternal alcohol consumption reduces birth weight by 147g for each daily unit, i.e., 26g at the mean alcohol consumption, and fetal growth by 3.7g/week, i.e., 1g/week at the mean alcohol consumption.
The findings from an analysis of light and heavy smokers/drinkers show that the results are driven by mothers who smoke/drink above average. There is additional indication of heterogeneous effects, as earlier studies also argue: smoking effects are more pronounced for younger mothers and those with lower education. Yet the effect of maternal alcohol consumption is driven by older mothers and mothers with a higher educational level.
Maternal employment during pregnancy—as also considered by some earlier studies—
displays a modest negative effect for the probability of preterm birth. As this finding for my
Danish sample stands in contrast to evidence from the UK and the U.S., the differences might be due to institutional and cultural factors leading to different selection processes.
As for the potential pitfalls of my study, I find that sample selection into my sibling sample based on observables and time-invariant unobservables is not an important problem.
Drawing different samples of multiple mothers from the administrative registry reveals differences in observables between participating and non-participating mothers. However, estimation results do not differ for maternal smoking. Furthermore, my analysis has shown that measurement error is a minor concern in my application. The comparison of the maternal survey report and the maternal report to the administrative registry suggests that the survey report is more trustworthy. This finding emphasizes the importance of timing and the way of measurement of inputs for the validity of estimation results. Finally, composite measures of behavior during pregnancy potentially cover over important changes in maternal behavior during pregnancy. This factor is worth exploring in future research in terms of indication of critical periods during pregnancy.
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Tables:
Table 1. Descriptive statistics. DNBC pooled sample and sibling sample.
Pooled sample
Sibling sample
Mean Std. Mean Std.
Child outcome variables
Birth weight, kg 3.59 0.55 3.64 0.53
Gestational age, weeks 39.6 1.65 39.68 1.54
Preterm birth, percentage 0.04 0.03
Child sex (female) 0.49 0.49
First born child 0.46 0.39
Maternal age at birth, years 29.96 4.27 29.59 3.83
Mother smoked during pregnancy, i1 Mother smoked, i2
Cigarettes/day for smokers, i1 Cigarettes/day for smokers, i2
0.26 0.16 8.25 8.68
5.63 5.38
0.19 0.11 8.17 8.49
5.34 5.9 Alcohol consumption, i1
>1 unit per week
Alcohol consumption, i2
>1 unit per week
Units per day for drinkers, i1 Units per day for drinkers, i2
0.24 0.31 0.26 0.28
0.18 0.19
0.26 0.33 0.24 0.27
0.16 0.19
BMI before pregnancy 23.59 4.25 23.5 4.19
Father smoked, i1 (N. of obs.: 79,444 in full sample; 9823 in sibling sample)
0.3 0.25
Maternal lm participation, i1 0.81 0.81
Maternal lm participation, i2 0.77 0.77
Number of observations with both survey waves:
- number of single children - number of sibling-pairs - number of sibling-triplets - number of mothers
79,482 69,652 4,844 47 74,544
9,829
Notes: i1: interview one, i2: interview two.
Table 2: Maternal smoking behavior during pregnancy.
Mother’s smoking type Share of pregnancies
Only smoking early in pregnancy (<i1) 0.074
Smoking until i1 0.008
Smoking longer than i1 (>i1) 0.016
Smoking until i2 0.16
Notes: i1: interview one, i2: interview two. The table assumes smoking to be constant for periods before the reporting date, e.g., mothers who report smoking until i1 are assumed to have been smoking without interruption prior to interview one.
Table 3: OLS estimates for birth weight, fetal growth and preterm birth.
(1) (2) (3) (4) (5) (6) Birth
weight, kg
Birth weight, kg
Fetal growth, g/week
Fetal growth, g/week
Preterm birth
Preterm birth Smoking
indicator
-0.240 -0.114 -5.8 -2.92 0.007 -0.003
(0.005)** (0.009)** (0.123)** (0.209)** (0.002)** (0.004) Number of
cig./day
-0.013 -0.305 0.001
(0.001)** (0.020)** (0.000)*
Alcohol indicator: 1 or more per week
0.020 0.373 -0.005
(0.006)** (0.144)** (0.002)*
Number of glasses/day
-0.045 -1.381 -0.002
(0.018)* (0.404)** (0.007)
BMI before pregnancy
0.017 0.402 0.000
(0.000)** (0.011)** (0.000)
Indicator for exercise during pregnancy
0.018 0.269 -0.009
(0.004)** (0.095)** (0.002)**
Indicator for fish
consumption
0.003 0.073 0.000
(0.001)** (0.023)** (0.000)
Employment indicator
0.008 0.027 0.07 0.171 -0.007 -0.012 (0.005) (0.005)** (0.106) (0.106) (0.002)** (0.002)**
Sick-listed -0.056 -0.745 0.035
(0.006)** (0.140)** (0.003)**
Observations 79482 79482 79482 79482 79482 79482
Notes: Robust standard errors in parentheses;* significant at 5% level; ** significant at 1%
level; Models additionally control for maternal education, maternal age group, birth year, cohabitation status, and child sex and parity.
Table 4. FE estimates for birth weight, fetal growth and preterm birth.
(1) (2) (3) (4) (5) Birth
weight, kg
Birth weight, kg
Fetal growth g/week
Fetal growth g/week
Preterm birth
Smoking indicator -0.108 -0.097 -2.687 -2.66 0.006 (0.036)** (0.042)* (0.808)** (0.951)** (0.018) Number of
cig./day
-0.001 0.016 -0.002
(0.004) (0.101) (0.002)
Alcohol indicator 0.015 0.625 -0.009
(0.022) (0.493) (0.009)
Number of glasses/day
-0.147 -3.7 0.078
(0.069)* (1.566)* (0.030)**
Indicator for exercise
-0.005 -0.130 -0.003
(0.014) (0.308) (0.006)
Indicator for fish consumption
-0.001 -0.038 0.001
(0.004) (0.089) (0.002)
BMI before pregnancy
0.005 0.200 0.002
(0.004) (0.099)* (0.002)
Employment indicator
0.012 0.018 -0.03 -0.02 -0.025 (0.016) (0.018) (0.370) (0.397) (0.007)**
Sick-listed -0.003 0.099 0.016*
(0.019) (0.425) (0.008)
Standard errors in parentheses; * significant at 5% level; ** significant at 1% level; Models additionally control for maternal education, maternal age group, birth year, cohabitation status, and child sex and parity. Number of obs.: 9829. Number of groups: 4891
Table 5. Heterogeneous effects for mothers in different age groups. FE estimation
(1) <=26 (2)27-33 (3)>33
Birth weight Birth weight Birth weight
Smoking indicator -0.185 -0.092 0.241
(0.071)** (0.063) (0.166)
Number of cig./day -0.001 0.001 -0.012
(0.007) (0.006) (0.022)
Alcohol indicator 0.010 0.030 -0.163
(0.044) (0.032) (0.069)*
Number of glasses/day -0.105 -0.224 0.075
(0.160) (0.106)* (0.176)
Indicator for exercise 0.012 -0.014 0.018
(0.024) (0.020) (0.047) Indicator for fish
consumption
0.002 -0.002 0.007 (0.007) (0.006) (0.013)
BMI before pregnancy 0.006 0.003 -0.006
(0.007) (0.007) (0.016)
Employment indicator 0.004 0.006 -0.029
(0.026) (0.027) (0.061)
Sick-listed 0.011 -0.011 -0.076
(0.030) (0.029) (0.065) Observations 3070 5228 1531
Number of groups 1527 2915 1075
Notes: Standard errors in parentheses. Age groups according to mother’s age at first birth in the sibling sample. * significant at 5% level; ** significant at 1% level. Models additionally control for maternal education, birth year, cohabitation status, and child sex and parity.
Table 6. Heterogeneous effects for mothers with different educational level. FE estimation.
Birth weight.
(1) Short education (2) Medium and long education
Birth weight Birth weight
Smoking indicator -0.142 -0.018
(0.050)** (0.080)
Number of cig./day -0.002 0.008
(0.005) (0.012)
Alcohol indicator 0.001 0.035
(0.029) (0.034)
Number of glasses/day -0.133 -0.164
(0.091) (0.109)
Indicator for exercise 0.015 -0.029
(0.018) (0.021) Indicator for fish
consumption
-0.006 0.006 (0.005) (0.006)
BMI before pregnancy 0.003 0.009
(0.005) (0.008)
Employment indicator 0.008 0.035
(0.021) (0.031)
Sick-listed 0.005 -0.022
(0.023) (0.033)
Observations 6004 3825
Number of groups 2986 1906
Standard errors in parentheses. Educational level according to mother’s age at first birth in the sibling sample. * significant at 5% level; ** significant at 1% level. Models additionally control for maternal age, birth year, cohabitation status, and child sex and parity.
Table 7: Differences between changing and non-changing mothers in the sibling sample.
Mothers who stop smoking between pregnancies
Mothers who smoke during both pregnancies
1st 2nd 1st 2nd
Mean number of units of alcohol/day, mean and std. dev.
0.62 (1.1) 0.59 (1.1) 0.68 (1.5) 0.68 (1.6) Number of cigarettes during first
observed pregnancy, mean and std. dev. **
4.6 (4.4) 8.7 (5.4)
Mother exercises, percent 31 11 20 16
Mother is employed during pregnancy, percent
78 71 71 67 Birth weight of first child, mean
and std. dev.
3.45 (0.53) 3.38 (0.53)
# of mothers 141 396
Notes: Sibling sample of mothers who participate twice in the DNBC, excluded: 3rd children of mothers in the sibling sample. Differences in means between mothers who stop smoking and continuously smoking mothers: * significant at 5% level; ** significant at 1% level.
Table 8: Descriptive statistics for different samples; means and std. dev.
(1) Mothers
who participate at least once in DNBC,
information on their births 1994-2003
(2) All mothers who have at least one eligible pregnancy in the period 1998-2003, information on their births 1994-2003
(3) Mothers who participate at least two times in DNBC, only births in the sampling period 1998-2003
(4) All mothers who have at least two eligible pregnancies in the period 1998-2003, only births in the sampling period 1998-2003
Birth weight 3.52 (0.56) [60 862]
3.47 (0.6) [237 934]
3.58 (0.53) [4 367]
3.42 (0.64) [85 967]
Mother’s age 28.54 (4.25) [61 483]
28.58 (4.81) [241 971]
28.3 (3.62) [4 410]
27.89 (4.33) [87 582]
Complicated prenatal check up
0.08 [61 272]
0.11 [240 089]
0.07 [4 400]
0.11 [87 068]
Smoking dummy 0.15 [48 929]
0.21 [182 198]
0.11 [4 196]
0.17 [78 902]
Note: All columns only contain mothers with multiple children. Means for first observed child after 1994 for each mother in the respective period. Number of observations (first child per mother) in brackets.
Table 9: Pooled OLS on different samples, only information from administrative registry data.
(1) Mothers
who participate at least once in DNBC, all their births 1994-2003
(2) All mothers who have at least one eligible pregnancy in the period 1998-2003, all their births 1994-2003
(3) Mothers who participate at least two times in DNBC, only births in the sampling period 1998-2003
(4) All mothers who have at least two eligible pregnancies in the period 1998-2003, only births in the sampling period 1998-2003
Birth weight Birth weight Birth weight Birth weight
Smoking dummy -0.229 -0.229 -0.228 -0.228
(0.006)** (0.003)** (0.022)** (0.005)**
Cohabitation status
0.027 (0.011)*
0.049 (0.005)**
0.063 (0.046)
0.056 (0.008)**
Dummy for complicated check up during pregnancy
-0.074 -0.115 0.013 -0.118 (0.005)** (0.003)** (0.017) (0.004)**
Child’s sex -0.127 -0.124 -0.120 -0.122
(0.003)** (0.002)** (0.011)** (0.003)**
# of observations 99 811 346 401 8 419 159 745
# of mothers 59 649 225 826 4 368 83 775
R-squared 0.04 0.05 0.04 0.05
Notes: All columns only contain mothers with multiple children. Only children born between 1994 and 2003 are included, due to data restrictions. Models additionally control for mothers’ educational group, age and age squared. Robust standard errors in parentheses.
The data on the different samples is only from the administrative registers. * significant at 5% level; ** significant at 1% level.
Table 10: FE estimation on different samples and using smoking information from administrative registry data only.
(1) Mothers who
participate at least two times in DNBC, only births in the sampling period 1998-2003 – registry
information only
(2) All mothers who have at least two eligible pregnancies in the period 1998-2003, only births in the sampling period 1998-2003 – registry information only
Birth weight, kg Birth weight, kg Smoking indicator (registry
data)
-0.055 -0.080 (0.035) (0.008)**
Cohabitation status 0.083 0.034
(0.051) (0.009)**
Dummy for complicated check up during pregnancy
0.018 0.050 (0.019) (0.005)**
Child’s sex -0.121 -0.132
(0.011)** (0.003)**
# of observations 8419 159745
# of mothers 4368 83836
Standard errors in parentheses. Models additionally control for mothers’ education, age and age squared. * significant at 5% level; ** significant at 1% level
Table 11: IV estimation for maternal smoking, outcome: Birth weight.
OLS OLS OLS IV (for survey report)
IV (for survey report, including missing values in registry as
smoking) Maternal smoking, survey
report
-.20 (0.008)**
-.25 (0.01)**
-.28 (0.01)**
Maternal smoking, registry -.20
(0.008)**
Maternal smoking, Survey=1, registry=1
-.24 (0.009)**
Maternal smoking, survey=1, registry=0
-.08 (0.016)**
Maternal smoking, survey=0, registry=1
-.01 (0.021)
# of children (sample of first born children)
35 270 35 270 35 270 35 270 36 843
Mother FE
Mother FE
Mother FE
FE-IV (for survey report)
IV (for survey report, including missing values in registry as
smoking) Maternal smoking, survey
report
-.107 (0.037)**
-.26 (0.17)
-.36 (0.23) Maternal smoking, registry -.05
(0.036) Maternal smoking,
Survey=1, registry=1
-.14 (0.047)*
Maternal smoking, survey=1, registry=0
-.081 (0.045)
Maternal smoking, survey=0, registry=1
.003 (0.053)
# of children 9 417 9 417 9 417 9 417 9 794
Notes: * significant at 5% level; ** significant at 1% level. OLS regressions contain controls as in Table 3 except for number of cigarettes smoked. FE estimates additionally control for indicator for first-born child.
Department of Economics:
Skriftserie/Working Paper:
2009:
WP 09-1 Tomi Kyyrä, Pierpaolo Parrotta and Michael Rosholm:
The Effect of Receiving Supplementary UI Benefits on Unemployment Duration
ISBN 9788778824035 (print); ISBN 9788778824042 (online) WP 09-2 Dario Pozzoli and Marco Ranzani: Old European Couples’
Retirement Decisions: the Role of Love and Money
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Globalization, Superstars, and the Importance of Reputation:
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Increased Sorting and Wage Inequality in the Czech Republic:
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Peer Effects, Social Networks, and Intergroup Competition in the Workplace
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Done Elsewhere?
ISBN 9788778824073 (print); ISBN 9788778824080 (online) WP 09-17 Lorenzo Cappellari, Claudio Lucifora and Dario Pozzoli:
Determinants of Grades in Maths for Students in Economics ISBN 9788778824103 (print); ISBN 9788778824110 (online) WP 09-18 Yingqiang Zhang and Tor Eriksson: Inequality of Opportunity
and Income Inequality in Nine Chinese Provinces, 1989-2006 ISBN 9788778824127 (print); ISBN 9788778824134 (online)