Pregnant women with low levels of education are nearly twice as likely as their more educated peers to give birth prematurely, researchers from the Netherlands report.
However, most of the risk can be attributed to the disadvantages that come with poor education, rather than educational level itself.
In fact, as Dr. Pauline W. Jansen told Reuters Health, "Factors identified in this study, such as young age, stressful circumstances, smoking habits, and overweight are modifiable by up-to-date interventions."
Jansen, at Erasmus MC-University Medical Center Rotterdam, and her colleagues investigated the characteristics of 3830 pregnant women of Dutch origin, age 31 years on average. Among them, 1264 reported high education (above the Bachelor's degree level) while 638 reported no more than 3 years of secondary school (the low group). The remaining women reported education levels somewhere in between.
The researchers found that the women with the lowest educational level were 89 percent more likely to have a preterm birth than the most highly educated women.
However, women with low education also seemed to accumulate psychosocial stress and unhealthy lifestyle factors "that turned out to be associated with their increased risk of preterm birth," Jansen and colleagues report in the Archives of Disease in Childhood--Fetal and Neonatal Edition.
For example, separate analyses for factors potentially related to preterm birth, including age, height, pregnancy related risk factors such as preeclampsia, financial concerns and long-lasting difficulties, psychological characteristics, smoking habits, alcohol consumption, and body mass, were each responsible for various degrees of risk.
The combination of all these factors accounted for all but 10 percent of the extra risk of preterm birth associated with low education.
This study explains "a large part of the excess risk of preterm birth among lower educated pregnant women," Jansen said.
She and colleagues suggest investment in policies that reduce modifiable risks for preterm birth, as well as further research of other possible explanatory factors, such as the interval between pregnancies, diet, or the presence of bacterial vaginosis.
