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In 2020, an estimated 287\u2009000 women died from preventable causes related to pregnancy, and in 2021, approximately 2.3 million neonatal deaths occurred within the first 28\u2009days of life. A recently defined risk group, small vulnerable newborns (SVNs, including preterm, low birth weight, and small\u2010for\u2010gestational\u2010age infants), highlights the compounded vulnerability of certain newborns. Maternal education is a key social determinant of health, yet its effect on maternal and perinatal outcomes across global settings remains insufficiently quantified.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Aims<\/jats:title>\n                    <jats:p>The primary aim of this study was to quantify the association between maternal education level and adverse maternal and perinatal outcomes. The secondary aim was to evaluate whether these associations vary by country income level.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We conducted an individual participant data (IPD) meta\u2010analysis using data from the International Prediction of Pregnancy Complications (IPPIC) Network. Eligible studies included those reporting maternal and perinatal outcomes stratified by at least two levels of maternal education (informal\/primary, secondary, tertiary). Primary outcomes were maternal mortality, preeclampsia, stillbirth, and SVNs. Associations were estimated using a two\u2010step random\u2010effects IPD meta\u2010analysis adjusted for maternal age and ethnicity. Odds ratios (ORs) and 95% confidence intervals (CIs) were reported.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Compared to tertiary education, women with secondary education had a 27% higher risk of maternal death (OR 1.27, 95% CI 0.38; 4.30), and those with informal or primary education had approximately double the risk (OR 2.51, 95% CI 0.23; 26.95). Risk of stillbirth was also twofold higher in lower education groups. These association remained significant in analyses restricted to high\u2010income countries.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Discussion<\/jats:title>\n                    <jats:p>Women with lower levels of education are at substantially greater risk of adverse maternal and perinatal outcomes. These findings reinforce the need for education\u2010focused policy and health system strategies to reduce maternal and neonatal mortality, particularly in settings with high educational inequality.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/ijgo.70401","type":"journal-article","created":{"date-parts":[[2025,7,28]],"date-time":"2025-07-28T11:20:09Z","timestamp":1753701609000},"page":"886-895","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":13,"title":["Effects of maternal education on maternal and perinatal outcomes: An individual participant data meta\u2010analysis of 2\u2009356\u2009402 pregnancies"],"prefix":"10.1002","volume":"172","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7285-5150","authenticated-orcid":false,"given":"Laura\u2010Margarita","family":"Bello\u2010\u00c1lvarez","sequence":"first","affiliation":[{"name":"Escuela de Doctorado, Doctorado en Epidemiolog\u00eda y Salud P\u00fablica Universidad Aut\u00f3noma de Madrid  Madrid Espa\u00f1a"},{"name":"Escuela de Medicina, Facultad de Salud Universidad del Valle  Cali Colombia"},{"name":"C\u00ednica Imbanaco, Cuidado Integral de la Mujer  Cali Colombia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8798-019X","authenticated-orcid":false,"given":"Borja M.","family":"Fern\u00e1ndez\u2010F\u00e9lix","sequence":"additional","affiliation":[{"name":"Unidad de Bioestad\u00edstica Cl\u00ednica, Hospital Ram\u00f3n y Cajal (IRYCIS), CIBERESP  Madrid Espa\u00f1a"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4134-6246","authenticated-orcid":false,"given":"Jhon","family":"Allotey","sequence":"additional","affiliation":[{"name":"WHO Collaborating Centre for Global Women's Health, Institute of Metabolism and Systems Research University of Birmingham  Birmingham UK"},{"name":"NIHR Birmingham Biomedical Centre (BRC) University Hospitals Birmingham  Birmingham UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4254-460X","authenticated-orcid":false,"given":"Shakila","family":"Thangaratinam","sequence":"additional","affiliation":[{"name":"Institute of Life Course and Medical Sciences, University of Liverpool  Liverpool UK"},{"name":"Liverpool Women's NHS Foundation Trust  Liverpool UK"},{"name":"NIHR North West Coast Applied Research Collaboration University of Liverpool  Liverpool UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4901-588X","authenticated-orcid":false,"given":"Javier","family":"Zamora","sequence":"additional","affiliation":[{"name":"Unidad de Bioestad\u00edstica Cl\u00ednica, Hospital Ram\u00f3n y Cajal (IRYCIS), CIBERESP  Madrid Espa\u00f1a"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2025,7,28]]},"reference":[{"key":"e_1_2_9_2_1","volume-title":"World Health Statistics 2023: Monitoring Health for the SDGs, Sustainable Development Goals","year":"2023"},{"key":"e_1_2_9_3_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmjgh-2021-007426"},{"key":"e_1_2_9_4_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(23)00354-9"},{"key":"e_1_2_9_5_1","volume-title":"The World's Women 2015. 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