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

• Published in: PloS one 2023-04, Vol.18 (4), p.e0283901-e0283901
• Main Authors: Granés, Laura, Torà-Rocamora, Isabel, Palacio, Montse, De la Torre, Laura, Llupià, Anna
• Format: Article
• Language: English
• Subjects: Biology and Life Sciences; Birth; Body mass; Body mass index; Body size; Body weight; Cohort analysis; Cohort Studies; Complications; Education; Educational Status; Evaluation; Female; Health Promotion; Health risks; Hospitals; Humans; Inequalities; Infant, Newborn; Infants (Premature); Medicine and Health Sciences; Obesity; Overweight; Pre-eclampsia; Preeclampsia; Pregnancy; Pregnancy complications; Pregnant women; Premature birth; Premature Birth - etiology; Retrospective Studies; Risk; Social Sciences; Socioeconomic factors; Womens health
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0283901

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.