Babies born too soon or too small face many difficulties, including increased rates of mortality and lifelong disability.1 The 2012 Global Action Report on Preterm Birth ‘Born Too Soon’ presents a sobering picture: 15 million (1 in 10) babies every year are born too soon, with these rates appearing to be rising globally.1 Low levels of maternal education have been clearly associated with adverse birth outcomes such as preterm birth and low birth weight.2–4 While education is only one risk factor—alongside other critical factors such as maternal age, birth order and spacing, multiple pregnancies, body weight, chronic disease, mental health, infectious diseases, health risk behaviours such as smoking, intimate partner violence, and access to screening and health services1 ,5—it matters, because education enables girls and women to make informed decisions about their reproductive health and interactions with the healthcare system.6 Increasing education levels is a key component of programmes directed at reducing adverse birth outcomes.1
While the prevalence (and burden) of preterm birth is highest in the poorest countries, namely sub-Saharan Africa and southern Asia, it also affects richer countries including those in the Americas and Europe. More country-specific data are needed to assist our understanding of the extent of the problem and the complex interplay of contributory risks. This is why the paper by Ruiz et al7 is a welcome addition to the literature. The authors examine the association between attained educational qualifications of mothers and two adverse birth outcomes (preterm birth, low for gestational age birth weight) in their infants. Conducted as part of the ‘DRIVERS for Health Equity’ research programme, this meta-analysis has systematically analysed data from studies of over 75 000 babies in 12 countries across Europe (France, the Netherlands, the UK, the Czech Republic, Ukraine, Finland, Norway, Sweden, Greece, Italy, Portugal and Spain). Notably, these countries represent the northern, western, southern and central/eastern parts of Europe, thus providing a more complete picture of how maternal education may influence disparities in pregnancy duration and infant birth weight.
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