Evidence map›Paper›PMID 40719251›Full record

SynthesisInternational journal of gynaecology and obstetrics: the official organ of the International Federation of Gynaecology and Obstetrics2026

Effects of maternal education on maternal and perinatal outcomes: An individual participant data meta-analysis of 2 356 402 pregnancies.

Laura-Margarita Bello-Álvarez, Borja M Fernández-Félix, Jhon Allotey, Shakila Thangaratinam, Javier Zamora

Abstract readMeta-Analysis
In one paragraph

Synthesis in International journal of gynaecology and obstetrics: the official organ of the International Federation of Gynaecology and Obstetrics, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 6 papers, 2 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
6citing papers in PubMed, 2 pooled it
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

6 citing papers in PubMed, 2 syntheses or guidelines pooled it.

  1. Pooled it
  2. Effects of maternal education on maternal and perinatal outcomes: An individual participant data meta-analysis of 2 356 402 pregnancies.International journal of gynaecology and obstetrics: the official organ of the International Federation of Gynaecology and Obstetrics · 2026
    Pooled it
  3. Article
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4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

5 authors.

Laura-Margarita Bello-ÁlvarezEscuela de Doctorado, Doctorado en Epidemiología y Salud Pública, Universidad Autónoma de Madrid, Madrid, España.ORCID https://orcid.org/0000-0002-7285-5150
Borja M Fernández-FélixUnidad de Bioestadística Clínica, Hospital Ramón y Cajal (IRYCIS), CIBERESP, Madrid, España.ORCID https://orcid.org/0000-0002-8798-019X
Jhon AlloteyWHO Collaborating Centre for Global Women's Health, Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, UK.ORCID https://orcid.org/0000-0003-4134-6246
Shakila ThangaratinamInstitute of Life Course and Medical Sciences, University of Liverpool, Liverpool, UK.ORCID https://orcid.org/0000-0002-4254-460X
Javier ZamoraUnidad de Bioestadística Clínica, Hospital Ramón y Cajal (IRYCIS), CIBERESP, Madrid, España.ORCID https://orcid.org/0000-0003-4901-588X

Funding

Instituto de Salud Carlos III PI24/0416Instituto de Salud Carlos III PI24/1406
6 · The paper itself

Abstract

backgroundMaternal and perinatal mortality remain critical indicators of global health inequity. In 2020, an estimated 287 000 women died from preventable causes related to pregnancy, and in 2021, approximately 2.3 million neonatal deaths occurred within the first 28 days of life. A recently defined risk group, small vulnerable newborns (SVNs, including preterm, low birth weight, and small-for-gestational-age infants), highlights the compounded vulnerability of certain newborns. Maternal education is a key social determinant of health, yet its effect on maternal and perinatal outcomes across global settings remains insufficiently quantified.

aimsThe primary aim of this study was to quantify the association between maternal education level and adverse maternal and perinatal outcomes. The secondary aim was to evaluate whether these associations vary by country income level.

methodsWe conducted an individual participant data (IPD) meta-analysis using data from the International Prediction of Pregnancy Complications (IPPIC) Network. Eligible studies included those reporting maternal and perinatal outcomes stratified by at least two levels of maternal education (informal/primary, secondary, tertiary). Primary outcomes were maternal mortality, preeclampsia, stillbirth, and SVNs. Associations were estimated using a two-step random-effects IPD meta-analysis adjusted for maternal age and ethnicity. Odds ratios (ORs) and 95% confidence intervals (CIs) were reported.

resultsCompared to tertiary education, women with secondary education had a 27% higher risk of maternal death (OR 1.27, 95% CI 0.38; 4.30), and those with informal or primary education had approximately double the risk (OR 2.51, 95% CI 0.23; 26.95). Risk of stillbirth was also twofold higher in lower education groups. These association remained significant in analyses restricted to high-income countries. DISCUSSION: Women with lower levels of education are at substantially greater risk of adverse maternal and perinatal outcomes. These findings reinforce the need for education-focused policy and health system strategies to reduce maternal and neonatal mortality, particularly in settings with high educational inequality.

Indexed as

Educational StatusPregnancy ComplicationsPregnancy OutcomeFemaleGlobal HealthHumansInfant, NewbornInfant, Small for Gestational AgeMaternal MortalityPerinatal MortalityPregnancyStillbirthhealth inqualitiesindividual participan datamaternal educationperinatal outcomesstillbirth

Identifiers

PMID40719251
PMCPMC12790673

What Socratic holds

Textmetadata
LicenceCC BY-NC-ND
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the Socratic graph.