Educational inequalities in adverse pregnancy outcomes in rural China, 2010-2018

Abstract

Background: Educational inequalities have been found in adverse pregnancy outcomes, but no previous study has investigated in China. This study examined the patterns of educational inequalities in the risk of adverse pregnancy outcomes in rural China and examined the mediations of birthweight and gestational age in the stillbirth and neonatal mortality. Methods: The study population consisted of 217,070 registered pregnancies in Yunnan Province during 2010–2018. Logistic regression models were performed on the association studies between education and adverse pregnancy outcomes including stillbirth, neonatal mortality, preterm birth (PTB), and low birth weight (LBW). The subgroup analysis by ethnicity was further carried out. Results: Compared to women with mid education, least educated women had a significantly increased risk of stillbirth (Adjusted OR (AOR) 1.36 [95%CI 1.19–1.56]), neonatal mortality (AOR 1.55 [1.29–1.87]), PTB (AOR 1.10 [1.04–1.16]), and LBW (AOR 1.30 [1.19–1.41]). Highly educated women showed a similar risk to least educated women in LBW. The magnitude of these associations differed among ethnic groups, among which education had a larger impact on neonatal mortality of Yi women and a smaller impact on stillbirth of Dai women. Low education level lead to stillbirth and neonatal mortality mainly by acting through birthweight. Conclusions: Education had the strongest link to neonatal mortality and the weakest link to PTB. Highly educated women also need concern on LBW. Improving education may reduce adverse pregnancy outcomes especially for Yi women in rural China.