Maternal education and its association with maternal and neonatal adverse outcomes in live births conceived using medically assisted reproduction (MAR)

BACKGROUND: To examine the association between maternal education and adverse maternal and neonatal outcomes in women who conceived using medically assisted reproduction, which included fertility medications, intrauterine insemination, or in vitro fertilization. METHODS: We conducted a retrospective cohort study utilizing the US Vital Statistics data set on national birth certificates from 2016 to 2020. Women with live, non-anomalous singletons who conceived using MAR and had education status of the birthing female partner recorded were included. Patients were stratified into two groups: bachelor’s degree or higher, or less than a bachelor’s degree. The primary outcome was a composite of maternal adverse outcomes: intensive care unit (ICU) admission, uterine rupture, unplanned hysterectomy, or blood transfusion. The secondary outcome was a composite of neonatal adverse outcomes: neonatal ICU admission, ventilator support, or seizure. Multivariable modified Poisson regression models with robust error variance adjusted for maternal age, race, marital status, prenatal care, smoking during pregnancy, neonatal sex, and birth year estimated the relative risk (RR) of outcomes with a 95% confidence interval (CI). RESULTS: 190,444 patients met the inclusion criteria: 142,943 had a bachelor’s degree or higher and 47,501 were without a bachelor’s degree. Composite maternal adverse outcomes were similar among patients with a bachelor’s degree (10.1 per 1,000 live births) and those without a bachelor’s degree (9.4 per 1,000 live births); ARR 1.05, 95% CI (0.94–1.17). However, composite adverse neonatal outcomes were significantly lower in women with a bachelor’s degree or higher (94.1 per 1,000 live births) compared to women without a bachelor’s degree (105.9 per 1,000 live births); ARR 0.91, 95% CI (0.88–0.94). CONCLUSIONS: Our study demonstrated that lower maternal education level was not associated with maternal adverse outcomes in patients who conceived using MAR but was associated with increased rates of neonatal adverse outcomes. As access to infertility care increases, patients who conceive with MAR may be counseled that education level is not associated with maternal morbidity. Further research into the association between maternal education level and neonatal morbidity is indicated.