Intrauterine Fetal Demise and Postneonatal Death Stratified by Maternal Education Level and Gestational Age [152

Abstract

INTRODUCTION: To evaluate the association between maternal education and the rates of intrauterine fetal demise and postneonatal death stratified by gestational age in a cohort of otherwise healthy women. METHODS: A retrospective cohort study was conducted using 2005 U.S. national linked birth certificate and death certificate data. Maternal education was defined as less than or equal to some level of high school education compared with college education or beyond. Intrauterine fetal demise was defined as death occurring at or after 20 weeks of gestation. Postneonatal death was defined as death from day 29 to 365 of life. Results were expressed as number of deaths per 10,000 live births. RESULTS: Overall, perinatal death rates per 10,000 were at least double in women receiving a high school education or less compared with the more educated cohort. Specifically, the rate of intrauterine fetal demise was 0.0029 compared with 0.0018 (P<.001), neonatal death was 0.0021 compared with 0.0012 (P<.001), postneonatal death was 0.0028 compared with 0.0011 (P<.001), and infant death was 0.0049 compared with 0.0024 (P<.001). However, when examined by week of gestation, although the rates of intrauterine fetal demise and postneonatal death were greater at every gestational age in those with a high school education or less, rates of neonatal death and infant death were quite similar between the two educational groups. CONCLUSION AND IMPLICATION: Rates of intrauterine fetal demise and post neonatal death were greater for every gestational age in less educated women when compared with their more educated cohort. Given that rates of neonatal death were approximately the same regardless of level of education brings up an interesting discrepancy. Environmental factors, inability to navigate the health care system, or lack of education in prenatal and postnatal care may all be contributing factors and would require further investigation.