Maternal educational level and preterm birth: Exploring inequalities in a hospital-based cohort study

Abstract

Preterm birth has been related to inequalities in maternal educational level, but the causal mechanism is not entirely known. Some factors associated with preterm birth and low educational level such as chronic medical conditions, pregnancy complications and related-health behaviours could have a mediation role in the pathway. This study aimed to evaluate the association between maternal educational level and preterm birth, analysing the mediation role of these factors. We performed a retrospective cohort study based on hospital electronic records of 10467 deliveries that took place in the Hospital Clínic of Barcelona between 2011 and 2017. Poisson regression was used to obtain crude and adjusted relative risk of preterm birth in women with different educational level and the percentage of change in relative risk was calculated when mediation variables were included in the model. Women with a lower educational level had a higher risk of preterm birth (RR 1.57, 95% CI 1.21, 2.03). The loss of association after the inclusion of body mass index in the model suggests an important mediation role of maternal overweight. Other variables such as smoking, drug use, preeclampsia and genitourinary infections also appear to play a role in the observed inequality between women with different levels of education. Efforts to promote health literacy and to improve preventive interventions, before and during pregnancy, could decrease preterm birth rates and perinatal health inequalities

Prevalence and associated risk factors of preterm and post-term births in Northern Ghana: a retrospective study in Savelugu Municipality

“…The current study demonstrated that mothers who completed junior high school had a reduced risk for preterm births. This is different from the findings of Wagura and colleagues (10) but similar to that of Spanish and Japanese cohort studies (34,35) which indicated that maternal lower All rights reserved. No reuse allowed without permission.…”

Dissecting the contribution of common variants to risk of rare neurodevelopmental conditions

“…Preterm delivery (i.e. giving birth prematurely) 55 , which is a risk factor for neurodevelopmental conditions in the offspring [45][46][47] , showed significant genetic correlations with lower educational attainment (rg=-0.30 [-0.39, -0.21], p=2.3x10 -10 ), mirroring the epidemiological association 56 , and with neurodevelopmental conditions (rg=0.58 [0.18, 0.97], p=0.004) (Extended Data Figure 8A, Supplementary Table 9). Premature birth was also associated with lower PGSEA in DDD (Extended Data Figure 8B).…”

“…This is consistent with epidemiological studies that found an association between prematurity and poorer neurocognitive outcomes even after controlling for socioeconomic confounders 45,[73][74][75][76][77][78][79] . We found some evidence from Mendelian randomization that lower educational attainment is causally associated with preterm delivery (Extended Data Figure 9B; Supplementary Note 5); this may be because lower educational attainment is associated with several factors that increase the risk of preterm delivery in the mother (such as a short inter-pregnancy interval 80 , exposure to tobacco smoke during pregnancy 81,82 , and pre-eclampsia 56 ). We acknowledge that causal estimates from Mendelian Randomization analyses may be biased when using population-based GWASs, as we have done, so these findings should be considered tentative until confirmed using sufficiently well-powered within-family GWASs 32 .…”

Continuity and discontinuity in infant and maternal behavior from 3 to 9 months according to prematurity status

“…Since in the VEPT sample, mothers were older and had fewer years of education; future studies should learn about the impact of these and other demographic factors on mother-infant interactive continuity, as found by past research (Granés et al, 2023).…”