Background The relationship between maternal education and adverse pregnancy outcomes is well documented. However, limited research has investigated maternal educational disparities in adverse pregnancy outcomes in China. This study examined maternal educational inequalities associated with adverse pregnancy outcomes in rural China.
Methods We conducted a population-based cohort study using participants enrolled in the National Free Preconception Health Examination Project in Yunnan province from 2010 to 2018. The primary outcome was stillbirth, and the secondary outcome was adverse pregnancy outcomes, defined as a composite event of stillbirth, preterm birth or low birth weight. The study was restricted to singleton births at 20–42 weeks’ gestation. Univariate and multivariate log-binomial regression models were performed to estimate crude risk ratios (RRs) and confounding-adjusted RRs (ARRs) for stillbirth and adverse pregnancy outcomes according to maternal education level.
Results A total of 197 722 singleton births were included in the study. Compared with mid-educated women, low-educated women were at a significantly increased risk of stillbirth (ARR, 1.20; 95% CI, 1.05 to 1.38) and adverse pregnancy outcomes (ARR, 1.11; 95% CI, 1.07 to 1.16). However, the risk of stillbirth (ARR, 1.16; 95% CI, 1.01 to 1.35) was significantly higher for high-educated women compared with mid-educated women.
Conclusion Compared with women with medium education level, women with lower education level were more likely to experience adverse pregnancy outcomes, including stillbirth, and women with higher education level were more likely to experience stillbirth.
Data availability statement
Data are available upon reasonable request. Not applicable.
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LL and YW contributed equally.
Contributors LL, YW (Yanpeng Wu), YW (Ying Wu) and DY were involved in study conception. YY and DY were involved in data curation. YY and DY obtained funding. LL, YW (Yanpeng Wu) and YW (Ying Wu) were involved in investigation and methodology design. LL completed statistical analysis. YW (Ying Wu), YZ and DY were involved in project administration. LL, YW (Yanpeng Wu) and YW (Ying Wu) were responsible for manuscript preparation and revision. LL and YW (Yanpeng Wu) were responsible for the overall content as the guarantor. All authors provided critical feedback on manuscript drafts and approved the final manuscript to be published.
Funding This research was funded by National Natural Science Foundation of China (grant numbers 81872710, 82073569, 81960592), Foundation of Yunnan Educational Committee (2016ZZX088) and Joint applied Basic Research Programmes of Science and Technology Commission Foundation of Yunnan Province and Kunming Medical University (2017FE468-21).
Competing interests None declared.
Provenance and peer review Not commissioned; externally peer reviewed.
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