Student or educator? Sign up with your school email and get 6 months of Pro free.
CoChat
Sign Up
Cited by 0Maternal and Neonatal HealthcareInfant Development and Preterm CareBirth, Development, and Health

The DOI matches its Crossref record; 48 of the 49 references it cites were found in a registry or an index, and 1 are not checked yet; none of the 20 sources its claims cite is checked for support yet.

Association of maternal educational attainment with preterm birth and low birth weight: A systematic review and meta-analysis

Open access
Tian, Yi-Gong, Huang, Sheng-Fan, Jin, Dong-Fang, Li, Sen-Li, Sun, Jin-Ke, Wang, Peng, Li, Zhi-Peng, Fan, Yan-Wei, Chen, Si-Si, Zhang, Chang-Jiang·2026·World Journal of Meta-Analysis
DOI 10.13105/wjma.126072
Open this paper in CoChat — free accountOpen PDF

Abstract

BACKGROUNDMaternal educational attainment is an important socioeconomic indicator associated with health literacy, healthcare access, and health-related behaviors.However, its association with preterm birth and low birth weight (LBW) varies across populations, educational classifications, and study settings. AIMTo determine the associations of maternal educational attainment with preterm birth and LBW. METHODSPubMed, Web of Science, EMBASE, and the Cochrane Library were searched from inception to August 6, 2026, for observational studies examining maternal education in relation to preterm birth or LBW.Study quality was assessed using the Newcastle-Ottawa Scale.Random-effects models pooled odds ratios (OR) and 95% confidence intervals (CI).Heterogeneity, subgroup analyses, leave-one-out sensitivity analyses, and potential small-study effects were evaluated.The protocol was registered in PROSPERO (CRD42024576198). RESULTSThirty-seven studies involving 30432601 births were included; 24 contributed to preterm birth analyses and 17 to LBW analyses, with four reporting both outcomes.For ≥ 12 years vs < 12 years of maternal education, higher attainment was associated with lower odds of preterm birth (OR = 0.82, 95%CI: 0.75-0.89)and LBW (OR = 0.83, 95%CI: 0.71-0.98).Heterogeneity was considerable for preterm birth (I² = 99.3%) and LBW (I² = 5 / 55 97.9%).Subgroup estimates varied by region, economic setting, and study design.Leave-one-out analyses did not materially alter the overall direction of associations. CONCLUSIONHigher maternal educational attainment was associated with lower odds of preterm birth and LBW, although substantial heterogeneity limits causal interpretation and generalizability.

Checked 2026-11-13 · 1 reference not checked yet

Overview

CoChat Summary

TL;DR

Higher maternal educational attainment was associated with lower odds of preterm birth and low birth weight in a meta-analysis of 37 observational studies. However, considerable heterogeneity and heterogeneous education definitions limit causal interpretation and generalizability.

Key findings

  • Among 37 studies representing 30,432,601 births, maternal education ≥ 12 years vs < 12 years was associated with lower odds of preterm birth (OR = 0.82, 95%CI: 0.75–0.89; I² = 99.3%) and low birth weight (OR = 0.83, 95%CI: 0.71–0.98; I² = 97.9%).
  • Preterm birth subgroup estimates were significant in the Americas (OR = 0.86, 95%CI: 0.75–0.98; I² = 99.7%), Asia (OR = 0.86, 95%CI: 0.76–0.97; I² = 92.8%), and Europe (OR = 0.74, 95%CI: 0.72–0.76; I² = 0.0%).
  • Low birth weight subgroup estimates were significant in Europe (OR = 0.81, 95%CI: 0.79–0.84; I² = 18.2%) and developed countries (OR = 0.76, 95%CI: 0.69–0.84), but not in developing countries (OR = 1.02, 95%CI: 0.82–1.27).
  • Leave-one-out analyses did not materially alter the direction or statistical interpretation of the overall pooled associations.

Methods

  • Systematic review and meta-analysis of observational studies (cohort, case-control, cross-sectional) published from 2010 onward, identified from PubMed, Web of Science, EMBASE, and the Cochrane Library through August 6, 2026; protocol registered in PROSPERO (CRD42024576198).
  • Thirty-seven studies were included; 24 contributed to preterm birth analyses and 17 to low birth weight analyses, with 4 reporting both outcomes.
  • Random-effects models pooled odds ratios and 95% confidence intervals; heterogeneity was assessed with I² and Cochran’s Q, with subgroup analyses by region, study design, and national economic level, plus leave-one-out sensitivity analyses and Egger’s tests.

Limitations

  • The paper states that all included studies were observational, so residual or unmeasured confounding cannot be excluded and causal inference is not warranted.
  • The paper states that differences in maternal educational attainment classification limited comparability and precluded a definitive dose-response assessment; methodological quality varied, and substantial residual heterogeneity persisted.
  • The paper states that some subgroup analyses included few studies, subgroup differences in statistical significance should not be interpreted as formal between-subgroup differences, and publication bias cannot be excluded because funnel plots and Egger’s tests had limited power.

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

Integrity signals

Registry

Crossref · 10.13105/wjma.126072

Cites

48 of 49 references verified0 citation errors · 0 not checkable

Statistics

Nothing to recompute.

Figures

Image 1
CC-BY-NC · From the PDF
Figure 2 Forest plots of the association between maternal educational attainment and preterm birth across pairwise education contrasts. The odds ratio (OR) in each panel compares the first-listed, higher education category with the second-listed, lower education category; OR < 1 indicates lower odds of preterm birth among mothers in the higher education category. A: > 16 years vs 12-16 years [pooled OR = 0.83, 95% confidence interval (CI): 0.69-0.99; I ² = 85.7%]; B: > 16 years vs 9-12 years (OR = 0.64, 95%CI: 0.50-0.82; I ² = 91.0%); C: 12-16 years vs 9-12 years (OR = 0.87, 95%CI: 0.79-0.95; I ² = 99.3%); D: 12-16 years vs 6-9 years (OR = 0.69, 95%CI: 0.61-0.78; I ² = 90.5%); E: 12-16 years vs ≤ 6 years (OR = 0.65, 95%CI: 0.44-0.96; I ² = 81.1%); F: 9-12 years vs 6-9 years (OR = 0.82, 95%CI: 0.76-0.88; I ² = 79.3%); G: 9-12 years vs ≤ 6 years (OR = 0.69, 95%CI: 0.550.86; I ² = 94.9%); H: 6-9 years vs ≤ 6 years (OR = 0.70, 95%CI: 0.53-0.92; I ² = 76.1%). Studyspecific ORs and 95%CIs are shown as squares and horizontal lines, respectively; square
Figure 2 Forest plots of the association between maternal educational attainment and preterm birth across pairwise education contrasts. The odds ratio (OR) in each panel compares the first-listed, higher education category with the second-listed, lower education category; OR < 1 indicates lower odds of preterm birth among mothers in the higher education category. A: > 16 years vs 12-16 years [pooled OR = 0.83, 95% confidence interval (CI): 0.69-0.99; I ² = 85.7%]; B: > 16 years vs 9-12 years (OR = 0.64, 95%CI: 0.50-0.82; I ² = 91.0%); C: 12-16 years vs 9-12 years (OR = 0.87, 95%CI: 0.79-0.95; I ² = 99.3%); D: 12-16 years vs 6-9 years (OR = 0.69, 95%CI: 0.61-0.78; I ² = 90.5%); E: 12-16 years vs ≤ 6 years (OR = 0.65, 95%CI: 0.44-0.96; I ² = 81.1%); F: 9-12 years vs 6-9 years (OR = 0.82, 95%CI: 0.76-0.88; I ² = 79.3%); G: 9-12 years vs ≤ 6 years (OR = 0.69, 95%CI: 0.550.86; I ² = 94.9%); H: 6-9 years vs ≤ 6 years (OR = 0.70, 95%CI: 0.53-0.92; I ² = 76.1%). Studyspecific ORs and 95%CIs are shown as squares and horizontal lines, respectively; squareCC-BY-NC · From the PDF
Figure 3 Forest plots of the association between maternal educational attainment and low birth weight across pairwise education contrasts. The odds ratio (OR) in each panel compares the first-listed, higher education category with the second-listed, lower education category; OR < 1 indicates lower odds of low birth weight among mothers in the higher education category. A: > 12 years vs 9-12 years [pooled OR = 0.88, 95% confidence interval (CI): 0.75-1.02; I ² = 96.9%]; B: > 12 years vs 6-9 years (OR = 0.69, 95%CI: 0.60-0.80; I ² = 83.7%); C: > 12 years vs ≤ 6 years (OR = 0.75, 95%CI: 0.44-1.29; I ² = 69.5%); D: 9-12 years vs 6-9 years (OR = 0.81, 95%CI: 0.74-0.88; I ² = 83.0%); E: 9-12 years
Figure 3 Forest plots of the association between maternal educational attainment and low birth weight across pairwise education contrasts. The odds ratio (OR) in each panel compares the first-listed, higher education category with the second-listed, lower education category; OR < 1 indicates lower odds of low birth weight among mothers in the higher education category. A: > 12 years vs 9-12 years [pooled OR = 0.88, 95% confidence interval (CI): 0.75-1.02; I ² = 96.9%]; B: > 12 years vs 6-9 years (OR = 0.69, 95%CI: 0.60-0.80; I ² = 83.7%); C: > 12 years vs ≤ 6 years (OR = 0.75, 95%CI: 0.44-1.29; I ² = 69.5%); D: 9-12 years vs 6-9 years (OR = 0.81, 95%CI: 0.74-0.88; I ² = 83.0%); E: 9-12 yearsCC-BY-NC · From the PDF
Figure 4 Subgroup analyses of the association between maternal educational attainment ≥ 12 years vs < 12 years and preterm birth. Odds ratio (OR) compare mothers with ≥ 12 years of education with those with < 12 years; OR < 1 indicates lower odds of preterm birth in the higher-education group. A: Geographic region. Pooled
Figure 4 Subgroup analyses of the association between maternal educational attainment ≥ 12 years vs < 12 years and preterm birth. Odds ratio (OR) compare mothers with ≥ 12 years of education with those with < 12 years; OR < 1 indicates lower odds of preterm birth in the higher-education group. A: Geographic region. PooledCC-BY-NC · From the PDF
Image 5
CC-BY-NC · From the PDF
Image 6
CC-BY-NC · From the PDF

Verification

Claims the paper makes

0 Valid · 0 Not valid · 15 Not checked · 130 Own results and interpretations

74 more claims

Create a free account to see all 145 claims and every source verdict.

See all claims — free account
  • It may state two separate claims as one. 45
  • Probably not a substantial claim. 33
  • The quote only partly states this claim. 1

Create a free account to see these claims.

Create a free account to see these assumptions.

Citations

Cites

Research works printed but not linked: 2

  1. Hu XL, Chen Y, Xia HP, Zhang YJ. [Analysis of maternal clinical risk factors for different degrees of small for gestational age infant]. Shanghai Jiaotong Daxue Xuebao (Yixueban) 2020; 40: 489-493 [DOI: 10.3969/j.issn.1674-8115.2020.04.012] · DOI
  2. Zhang X, Zhou M, Chen L, Hao B, Zhao G. Risk factors for preterm birth: a case- control study in rural area of western China. Int J Clin Exp Med 2015; 8: 4527-4532 [PMID: 26064379]

Cited by

Still being checked.

Related

See all

Metadata

Authors
Tian, Y.-G., Huang, S.-F., Jin, D.-F., Li, S.-L., Sun, J.-K., Wang, P., Li, Z.-P., Fan, Y.-W., Chen, S.-S., & Zhang, C.-J.
Affiliations
Fifth Affiliated Hospital of Zhengzhou University (CN)
Venue
World Journal of Meta-Analysis
Publisher
Baishideng Publishing Group Inc.
Published
2026-10-08
ISSN
2308-3840 (ISSN-L)
DOI
10.13105/wjma.126072
OpenAlex
W7220896472
Cited by
0
References
48
FWCI
0.00
Type
journal article
Language
en
Open access
Licence
cc-by-nc
Locations
World Journal of Meta-Analysis (publishedVersion, cc-by-nc)
Topics
  • Health Sciences › Medicine › Pediatrics, Perinatology and Child Health › Maternal and Neonatal Healthcare
  • Health Sciences › Medicine › Pediatrics, Perinatology and Child Health › Infant Development and Preterm Care
  • Health Sciences › Medicine › Pediatrics, Perinatology and Child Health › Birth, Development, and Health
Keywords
maternal educational attainment, preterm birth, low birth weight, socioeconomic status, maternal education, birth outcomes, health literacy, health care access

About these checks

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.

What counts as a claim ›How we measure confidence ›How we check this ›

Are you an author, or do you see a problem with this page? Request a review

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.