{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,4,27]],"date-time":"2025-04-27T02:23:45Z","timestamp":1745720625715,"version":"3.37.3"},"reference-count":36,"publisher":"Georg Thieme Verlag KG","issue":"S 01","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Am J Perinatol"],"published-print":{"date-parts":[[2024,5]]},"abstract":"<jats:p>\n            Objective\u2003The aim of the study is to determine the relation between education and adverse outcomes in individuals with pregestational or gestational diabetes.<\/jats:p><jats:p>\n            Study Design\u2003This population-based cohort study, using the U.S. vital statistics datasets, evaluated individuals with pregestational or gestational diabetes who delivered between 2016 and 2019. The primary outcome was composite neonatal adverse outcome including any of the following: large for gestational age (LGA), Apgar's score &lt;five at 5\u2009minutes, assisted ventilation &gt;6\u2009hours, neonatal seizure, or neonatal death. The secondary outcome was composite maternal adverse outcomes including any of the following: admission to intensive care unit, transfusion, uterine rupture, or unplanned hysterectomy. Multivariable analysis was used to estimate adjusted relative risks (aRR) and 95% confidence intervals (CIs).<\/jats:p><jats:p>\n            Results\u2003Of 15,390,962 live births in the United States, 858,934 (5.6%) were eligible for this analysis. Compared with individuals with a college education and above, the risk of composite neonatal adverse outcome was higher in individuals with some college (aRR\u2009=\u20091.08, 95% CI\u2009=\u20091.07\u20131.09), high school (aRR\u2009=\u20091.06, 95% CI\u2009=\u20091.04\u20131.07), and less than high school (aRR\u2009=\u20091.05, 95% CI\u2009=\u20091.03\u20131.07) education. The components of composite neonatal adverse outcome that differed significantly between the groups were LGA, Apgar's score &lt;five at 5\u2009minutes, and assisted ventilation for &gt;6\u2009hours. Infant death differed when stratified by education level. An increased risk of composite maternal adverse outcome was also found with a lower level of education.<\/jats:p><jats:p>\n            Conclusion\u2003Among individuals with diabetes, lower education was associated with a modestly higher risk of adverse neonatal and maternal outcomes.<\/jats:p><jats:p>\n            Key Points\n          <\/jats:p>","DOI":"10.1055\/a-1883-0064","type":"journal-article","created":{"date-parts":[[2022,6,23]],"date-time":"2022-06-23T23:06:05Z","timestamp":1656025565000},"page":"e353-e361","source":"Crossref","is-referenced-by-count":1,"special_numbering":"S","title":["Maternal Education Level Among People with Diabetes and Associated Adverse Outcomes"],"prefix":"10.1055","volume":"41","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4715-566X","authenticated-orcid":false,"given":"Michal","family":"Fishel Bartal","sequence":"additional","affiliation":[{"name":"Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology, and Reproductive Sciences, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, Texas"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Han-Yang","family":"Chen","sequence":"additional","affiliation":[{"name":"Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology, and Reproductive Sciences, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, Texas"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Joycelyn A.","family":"Ashby Cornthwaite","sequence":"additional","affiliation":[{"name":"Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology, and Reproductive Sciences, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, Texas"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2715-2755","authenticated-orcid":false,"given":"Stephen M.","family":"Wagner","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, Warren Alpert Medical School, Brown University, Providence, Rhode Island"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sarah A.","family":"Nazeer","sequence":"additional","affiliation":[{"name":"Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology, and Reproductive Sciences, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, Texas"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Suneet P.","family":"Chauhan","sequence":"additional","affiliation":[{"name":"Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology, and Reproductive Sciences, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, Texas"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hector","family":"Mendez-Figueroa","sequence":"additional","affiliation":[{"name":"Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology, and Reproductive Sciences, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, Texas"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"194","published-online":{"date-parts":[[2022,9,12]]},"reference":[{"volume-title":"Births: Final Data for 2019. 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Specific birth defects in pregnancies of women with diabetes: National Birth Defects Prevention Study, 1997\u20132011","volume":"2","author":"S C Tinker","year":"2020","journal-title":"Am J Obstet Gynecol"},{"issue":"S 01","key":"ref6","doi-asserted-by":"crossref","first-page":"S200","DOI":"10.2337\/dc21-S014","article-title":"14. Management of diabetes in pregnancy: Standards of Medical Care in Diabetes-2021","volume":"44","author":"A D Association","year":"2021","journal-title":"Diabetes Care"},{"issue":"02","key":"ref7","doi-asserted-by":"crossref","first-page":"229","DOI":"10.1177\/0145721706286572","article-title":"Sustaining a diabetes in pregnancy program: a continuous quality improvement process","volume":"32","author":"M Pagano","year":"2006","journal-title":"Diabetes Educ"},{"issue":"02","key":"ref8","doi-asserted-by":"crossref","first-page":"e49","DOI":"10.1097\/AOG.0000000000002501","article-title":"ACOG practice bulletin no. 190: gestational diabetes mellitus","volume":"131","author":"Bulletins\u2014Obstetrics CoP","year":"2018","journal-title":"Obstet Gynecol"},{"issue":"06","key":"ref9","doi-asserted-by":"crossref","first-page":"e228","DOI":"10.1097\/AOG.0000000000002960","article-title":"ACOG practice bulletin no. 201: pregestational diabetes mellitus","volume":"132","author":"American College of 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Med"},{"issue":"02","key":"ref12","doi-asserted-by":"crossref","first-page":"331","DOI":"10.2337\/diacare.27.2.331","article-title":"Health literacy and pregnancy preparedness in pregestational diabetes","volume":"27","author":"L K Endres","year":"2004","journal-title":"Diabetes Care"},{"issue":"01","key":"ref13","doi-asserted-by":"crossref","first-page":"2","DOI":"10.1186\/s12939-017-0715-7","article-title":"Socioeconomic status can affect pregnancy outcomes and complications, even with a universal healthcare system","volume":"17","author":"M K Kim","year":"2018","journal-title":"Int J Equity Health"},{"issue":"10","key":"ref14","doi-asserted-by":"crossref","first-page":"e13593","DOI":"10.1371\/journal.pone.0013593","article-title":"Economic inequalities in maternal health care: prenatal care and skilled birth attendance in India, 1992-2006","volume":"5","author":"P K Pathak","year":"2010","journal-title":"PLoS 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Borrell","year":"2006","journal-title":"Am J Public Health"},{"issue":"02","key":"ref25","doi-asserted-by":"crossref","first-page":"e172","DOI":"10.1016\/j.orcp.2013.04.003","article-title":"The effect of educational status on the relationship between obesity and risk of type 2 diabetes","volume":"8","author":"I S Madjid","year":"2014","journal-title":"Obes Res Clin Pract"},{"key":"ref26","doi-asserted-by":"crossref","first-page":"212","DOI":"10.1016\/j.diabres.2017.03.015","article-title":"The impact of level of education on vascular events and mortality in patients with type 2 diabetes mellitus: Results from the ADVANCE study","volume":"127","author":"J I Blomster","year":"2017","journal-title":"Diabetes Res Clin Pract"},{"issue":"19","key":"ref27","doi-asserted-by":"crossref","first-page":"2584","DOI":"10.1080\/14767058.2017.1347923","article-title":"Determinants of gestational diabetes mellitus: a case-control study","volume":"31","author":"B E 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Chung","year":"2006","journal-title":"J Perinatol"},{"issue":"12","key":"ref31","doi-asserted-by":"crossref","first-page":"1176","DOI":"10.1080\/10410236.2015.1037426","article-title":"Health literacy research and practice: a needed paradigm shift","volume":"30","author":"A Pleasant","year":"2015","journal-title":"Health Commun"},{"issue":"12","key":"ref32","doi-asserted-by":"crossref","first-page":"e0227007","DOI":"10.1371\/journal.pone.0227007","article-title":"Health literacy as a mediator of the relationship between socioeconomic status and health: a cross-sectional study in a population-based sample in Florence","volume":"14","author":"V Lastrucci","year":"2019","journal-title":"PLoS One"},{"key":"ref33","doi-asserted-by":"crossref","first-page":"975","DOI":"10.1186\/s12889-016-3621-9","article-title":"Examining health literacy disparities in the United States: a third look at the National Assessment of Adult Literacy (NAAL)","volume":"16","author":"R V 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