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Cited by 155Maternal and Neonatal HealthcareBirth, Development, and HealthMaternal and Perinatal Health Interventions

The DOI matches its Crossref record; 33 of the 34 references it cites were found in a registry or an index; none of the 19 sources its claims cite is checked for support yet.

Maternal education level and low birth weight: a meta-analysis

Open access
Silvestrin, Sonia, da Silva, Clécio Homrich, Hirakata, Vânia Naomi, Goldani, André A.S., Silveira, Patrícia P., Goldani, Marcelo Z.·2013·Jornal de Pediatria
DOI 10.1016/j.jped.2013.01.003
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Abstract

To assess the association between maternal education level and birth weight, considering the circumstances in which the excess use of technology in healthcare, as well as the scarcity of these resources, may result in similar outcomes. A meta-analysis of cohort and cross-sectional studies was performed; the studies were selected by systematic review in the MEDLINE database using the following Key**words socioeconomic factors, infant, low birth weight, cohort studies, cross-sectional studies. The summary measures of effect were obtained by random effect model, and its results were obtained through forest plot graphs. The publication bias was assessed by Egger's test, and the Newcastle-Ottawa scale was used to assess study quality. The initial search found 729 articles. Of these, 594 were excluded after reading the title and abstract; 21, after consensus meetings among the three reviewers; 102, after reading the full text; and three for not having the proper outcome. Of the nine final articles, 88.8% had quality ≥ six stars (Newcastle-Ottawa Scale), showing good quality studies. The heterogeneity of the articles was considered moderate. High maternal education showed a 33% protective effect against low birth weight, whereas medium degree of education showed no significant protection when compared to low maternal education. The hypothesis of similarity between the extreme degrees of social distribution, translated by maternal education level in relation to the proportion of low birth weight, was not confirmed. Analisar a associação entre grau de escolaridade materna e peso de nascimento, considerando-se a hipótese de que a utilização em excesso das tecnologias na área da saúde, assim como a escassez de recursos, pode produzir desfechos similares. Realizou-se uma meta-análise com estudos transversais e de coorte, selecionados por revisão sistemática na base de dados bibliográficos MEDLINE com os descritores: socioeconomic factors; infant, low birth weight; cohort studies; cross-sectional studies. As medidas de sumário de efeito foram obtidas pelo modelo de efeito aleatório, e os seus resultados apresentados por intermédio dos gráficos Forest Plot. O viés de publicação foi analisado pelo Teste de Egger, e a avaliação da qualidade dos estudos utilizou a Escala de Newcastle-Ottawa. A busca inicial encontrou 729 artigos. Destes, foram excluídos 594, após a leitura do título e do resumo; 21, após reuniões de consenso entre os três revisores; 102, após leitura do texto completo; e três, por não possuírem o desfecho adequado. Dos nove artigos finais, 88,8% apresentavam uma qualidade igual ou superior a seis estrelas (Escala de Newcastle-Ottawa), configurando boa qualidade aos estudos. A heterogeneidade dos artigos foi considerada moderada. A escolaridade materna elevada mostrou um efeito protetor de 33% sobre o baixo peso ao nascer, enquanto que o grau médio não apresentou proteção significativa, quando comparados à escolaridade materna baixa. A hipótese de similaridade entre os graus extremos da distribuição social, traduzidas pelo nível de escolaridade materna, em relação à proporção de baixo peso ao nascer, não foi confirmada.

Overview

CoChat Summary

TL;DR

This meta-analysis tested whether low birth weight (LBW) is similarly elevated at both extremes of maternal education (“similarity in inequality”). It found that high maternal education was protective against LBW, while medium education showed no significant protection compared with low education, so the similarity hypothesis was not confirmed.

Key findings

  • High maternal education vs low education was associated with a 33% lower risk of LBW: summary RR 0.67 (95% CI 0.51–0.88), with moderate heterogeneity (I² = 66.6%) and no evidence of publication bias by Egger’s test (p = 0.148).
  • Medium maternal education vs low education showed no significant protective effect: summary RR 0.86 (95% CI 0.70–1.06), with moderate heterogeneity (I² = 70.4%) and evidence of publication bias (Egger’s p = 0.027); after trim-and-fill estimated five missing studies, the corrected summary effect was 0.71 (95% CI 0.56–0.88).
  • Nine articles were included, covering 70,900 mother-child pairs; 88.8% had Newcastle-Ottawa quality ≥6 stars. LBW proportions did not show a similar distribution across education levels or a higher prevalence at both extremes.
  • The authors’ “similarity in inequality” hypothesis was not confirmed.

Methods

  • Systematic review of MEDLINE until November 2011 using MeSH terms for socioeconomic factors, infant low birth weight, and cohort or cross-sectional studies; inclusion required LBW (<2,500 g) as outcome and maternal schooling divided into low, medium, and high strata. Two independent reviewers selected articles, with a third resolving disagreements.
  • Nine cross-sectional or cohort studies were meta-analyzed. Data were analyzed in absolute numbers using low maternal education as the reference, comparing high and medium education separately with low education.
  • Summary effects used a random-effects model; heterogeneity was assessed with I²; publication bias was assessed by funnel plot and Egger’s test, with trim-and-fill used to adjust for possible bias. Study quality was assessed with the Newcastle-Ottawa scale.

Limitations

  • The paper states that many included articles had additional social variables and little information on individual maternal characteristics, and that maternal education was often classified in more than three strata or without clear high/medium/low definitions, which could influence findings.
  • The paper also states that many studies had small or medium samples, that larger studies could influence final results, and that the included articles span almost three decades.
  • Evident from the text: only nine observational studies were included, heterogeneity was moderate in both meta-analyses, and the medium-education analysis showed publication bias requiring trim-and-fill correction.

Model-written summary. Check it against the paper before relying on it.

Integrity signals

Registry

Crossref · 10.1016/j.jped.2013.01.003

Cites

33 of 33 references verified0 citation errors · 0 not checkable

Statistics

Nothing to recompute.

Figures

Figure 2 Forest plot of the effect of high maternal education level, when compared to low education level, on low birth weight. LBW, low birth weight; RR, relative risk; CI, confidence interval.
Figure 2 Forest plot of the effect of high maternal education level, when compared to low education level, on low birth weight. LBW, low birth weight; RR, relative risk; CI, confidence interval.CC-BY-NC-ND · From the PDF
Figure 3 Forest plot of the effect of high-school maternal education level, when compared to low education level, on low birth weight. LBW, low birth weight; RR, relative risk; CI, confidence interval.
Figure 3 Forest plot of the effect of high-school maternal education level, when compared to low education level, on low birth weight. LBW, low birth weight; RR, relative risk; CI, confidence interval.CC-BY-NC-ND · From the PDF

Verification

Claims the paper makes

0 Valid · 0 Not valid · 17 Not checked · 12 Own results and interpretations

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  • It may state two separate claims as one. 14
  • Probably not a substantial claim. 8

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Self-check

Percentages, sums and reported differences re-computed from the paper’s own numbers.

Each contradiction between two passages listed here was confirmed by an independent check.

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Citations

Cites

Show all 34 references

Research works printed but not linked: 1

  1. Goldani, 2012, The impact of demographic and epidemiological transition in the health of children and adolescents in Brazil, Rev HCPA & Fac Med Univ Fed Rio Gd do Sul, 32, 49

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Metadata

Authors
Silvestrin, S., da Silva, C. H., Hirakata, V. N., Goldani, A. A. S., Silveira, P. P., & Goldani, M. Z.
Affiliations
  • Universidade Federal do Rio Grande do Sul (BR)
  • Hospital de Clínicas de Porto Alegre (BR)
Corresponding author
Silvestrin, Sonia
ORCID
Venue
Jornal de Pediatria
Publisher
Elsevier BV
Published
2013-07
Volume
89
Issue
4
Pages
339-345
ISSN
0021-7557 (ISSN-L)
DOI
10.1016/j.jped.2013.01.003
OpenAlex
W1605258932
Semantic Scholar
7d046d6a6e41bb1cadbcadca64cbc309da50326e
Cited by
155
References
34
Citations by year
2026: 11 · 2025: 12 · 2024: 10 · 2023: 14 · 2022: 16 · 2021: 24 · 2020: 17 · 2019: 12 · 2018: 11 · 2017: 13 · 2016: 6 · 2015: 6 · 2014: 3
FWCI
0.69
Type
journal article
Language
en
Open access
Licence
Locations
  • Jornal de Pediatria (publishedVersion, cc-by-nc-nd)
  • PubMed (publishedVersion)
  • Americanae (AECID Library) (publishedVersion, other-oa)
  • LA Referencia (Red Federada de Repositorios Institucionales de Publicaciones Científicas) (publishedVersion, other-oa)
  • Lume (Universidade Federal do Rio Grande do Sul) (submittedVersion, cc-by-nc-sa)
  • Americanae (AECID Library) (submittedVersion, cc-by-nc-nd)
  • DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
  • DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion)
  • Redalyc (Universidad Autónoma del Estado de México) (submittedVersion)
Topics
  • Health Sciences › Medicine › Pediatrics, Perinatology and Child Health › Maternal and Neonatal Healthcare
  • Health Sciences › Medicine › Pediatrics, Perinatology and Child Health › Birth, Development, and Health
  • Health Sciences › Medicine › Obstetrics and Gynecology › Maternal and Perinatal Health Interventions
Keywords
maternal education, low birth weight, socioeconomic factors, maternal education level, birth weight
MeSH terms
Cross-Sectional Studies, Educational Status, Female, Humans, Infant, Low Birth Weight, Infant, Newborn, Mothers, Social Class, Models, Statistical, Cohort Studies, Publication Bias, Biomedical Research

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Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.

A language model drew the claims from the paper on 2026-11-13, under version 3 of the claim definition (model deepseek-v4.1-flash, prompt extract-v3).

A second model labelled each claim on 2026-11-13 (model jev-1.13-20260917, definition revision gold-guideline-v0.2).

Statistics and arithmetic are recomputed, not judged.

Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.

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Data sources

Bibliographic data: Semantic Scholar, OpenAlex, Crossref.

Contains information from the Semantic Scholar Academic Graph Datasets, made available under the ODC Attribution License (ODC-BY 1.0).

Semantic Scholar’s data is described in: Kinney, R., et al. (2023). The Semantic Scholar Open Data Platform. arXiv:2301.10140.