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Am J Perinatol 2024; 41(S 01): e353-e361
DOI: 10.1055/a-1883-0064
Original Article

Maternal Education Level Among People with Diabetes and Associated Adverse Outcomes

Michal Fishel Bartal 
1   Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology, and Reproductive Sciences, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, Texas
,
Han-Yang Chen
1   Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology, and Reproductive Sciences, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, Texas
,
Joycelyn A. Ashby Cornthwaite
1   Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology, and Reproductive Sciences, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, Texas
,
Stephen M. Wagner 
2   Department of Obstetrics and Gynecology, Warren Alpert Medical School, Brown University, Providence, Rhode Island
,
Sarah A. Nazeer
1   Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology, and Reproductive Sciences, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, Texas
,
Suneet P. Chauhan
1   Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology, and Reproductive Sciences, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, Texas
,
Hector Mendez-Figueroa
1   Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology, and Reproductive Sciences, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, Texas
› Author Affiliations Funding None.
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Abstract

Objective The aim of the study is to determine the relation between education and adverse outcomes in individuals with pregestational or gestational diabetes.

Study Design This population-based cohort study, using the U.S. vital statistics datasets, evaluated individuals with pregestational or gestational diabetes who delivered between 2016 and 2019. The primary outcome was composite neonatal adverse outcome including any of the following: large for gestational age (LGA), Apgar's score <five at 5 minutes, assisted ventilation >6 hours, neonatal seizure, or neonatal death. The secondary outcome was composite maternal adverse outcomes including any of the following: admission to intensive care unit, transfusion, uterine rupture, or unplanned hysterectomy. Multivariable analysis was used to estimate adjusted relative risks (aRR) and 95% confidence intervals (CIs).

Results Of 15,390,962 live births in the United States, 858,934 (5.6%) were eligible for this analysis. Compared with individuals with a college education and above, the risk of composite neonatal adverse outcome was higher in individuals with some college (aRR = 1.08, 95% CI = 1.07–1.09), high school (aRR = 1.06, 95% CI = 1.04–1.07), and less than high school (aRR = 1.05, 95% CI = 1.03–1.07) education. The components of composite neonatal adverse outcome that differed significantly between the groups were LGA, Apgar's score <five at 5 minutes, and assisted ventilation for >6 hours. Infant death differed when stratified by education level. An increased risk of composite maternal adverse outcome was also found with a lower level of education.

Conclusion Among individuals with diabetes, lower education was associated with a modestly higher risk of adverse neonatal and maternal outcomes.

Key Points

  • Education levels were associated with adverse outcomes among individuals with diabetes.

  • Lower education is associated with multiple neonatal complications, including infant death.

  • Individuals with varying levels of education are at higher risk for adverse maternal outcomes.

Keywords

diabetes - gestational diabetes - education - adverse maternal outcome


Publication History

Received: 31 May 2022

Accepted: 17 June 2022

Accepted Manuscript online:
23 June 2022

Article published online:
12 September 2022

© 2022. Thieme. All rights reserved.

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333 Seventh Avenue, 18th Floor, New York, NY 10001, USA

 

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