Interventions for type 2 diabetes (T2D), body mass index (BMI), high-density lipoprotein cholesterol levelHDL-C, smoking, and systolic blood pressure(SBP) may mitigate the impact of lower education levels on adverse pregnancy outcomes, according to a recent study published in JAMA Network Open.
Takeaways
- The study suggests that interventions targeting cardiometabolic factors such as type 2 diabetes (T2D), body mass index (BMI), high-density lipoprotein cholesterol level (HDL-C), smoking, and systolic blood pressure (SBP) may help mitigate the impact of lower education levels on adverse pregnancy outcomes.
- The research found a consistent association between education level and various pregnancy outcomes. Individuals with higher education levels exhibited lower odds ratios for ectopic pregnancy and preeclampsia, while education level was also linked to increased birth weight.
- The study employed a 2-sample mendelian randomization cohort study using summary level data from genome-wide association studies (GWAS). Genetic instruments for education level were extracted, and outcomes such as ectopic pregnancy, hyperemesis gravidarum, and gestational diabetes were evaluated.
- The analysis revealed that higher levels of T2D, BMI, smoking, and SBP were associated with increased risks of various adverse pregnancy outcomes, including gestational diabetes, preeclampsia, preterm birth, ectopic pregnancy, and altered birth weight.
- The study concludes by recommending interventions to improve factors such as BMI, SBP, smoking, T2D, and HDL-C levels. Addressing these factors could potentially help reduce the disparities in adverse pregnancy outcomes associated with lower education levels.
While education level has been associated with adverse pregnancy outcomes, there are disparities in access to further education, and many individuals experience difficulties in modifying their level of education. Cardiometabolic risk factors have been identified as potential mediators.
BMI and SBP have been linked to the association between education level and gestational hypertension and preeclampsia, and smoking to the association between education level and low birth weight and preterm birth. However, many outcomes such as ectopic pregnancy, hyperemesis gravidarum, and gestational diabetes have not been evaluated for mediating factors.
To evaluate mediating factors for the association between education level and adverse pregnancy outcomes, investigators conducted a 2-sample mendelian randomization cohort study. Summary level data from genome-wide association studies (GWAS) was used in the analysis, with data extraction occurring from December 1, 2022, to April 30, 2023.
The largest available GWAS was evaluated to extract genetic instruments for education level. Level of education was mapped to an International Standard Classification of Education 1997 category, and a mean education level of 15.4 years was reported.
Ectopic pregnancy, hyperemesis gravidarum, and gestational diabetes were primary outcomes of the analysis. Genetic associations of these outcomes were extracted from publicly available GWAS summary statistics. Additional outcomes included preeclampsia, birth weight, and preterm birth.
Mediators were chosen based on the American Heart Association’s 2023 scientific statement. These included T2D, BMI, HDL-C level, smoking, and SBP.
There were 3,037,499 individuals evaluated across 71 cohorts. Educational attainment was associated with all pregnancy outcomes, with an odds ratio (OR) of 0.53 for ectopic pregnancy and 0.81 for preeclampsia. Education level was also associated with increased birth weight.
An association was found between all measured cardiometabolic mediators with at least 1 pregnancy outcome. Increased T2D was associated with higher gestational diabetes, preeclampsia, and preterm birthrisks, with ORs of 1.66, 1.15, and 10.5, respectively. Birth weight risk increased by 9.41.
Higher BMI was also associated with increased ectopic pregnancy, gestational diabetes, preeclampsia, and greater birth weight risks, with ORs of 1.13, 1.55, and 1.25, respectively, and a birth weight increase of 38.34. Smoking had an OR of 1.84 for ectopic pregnancy.
Higher HDL-C level had ORs of 0.92, 0.77, and 0.86 for ectopic pregnancy, gestational diabetes, and preeclampsia, respectively. Birth weight was reduced by 15.98. SBP was associated with increased gestational diabetes, preeclampsia, preterm birth risks, as well as reduced birth weight, with ORs of 1.15, 2.88, 1.16, and -141.07, respectively.
These results indicated BMI, SBP, smoking, T2D, and HDL-C level impact the association between educational level and adverse pregnancy outcomes. Investigators recommended interventions to improve these factors be implemented.
Reference
Rogne T, Gill D, Liew Z, et al. Mediating factors in the association of maternal educational level with pregnancy outcomes: A mendelian randomization study. JAMA Netw Open. 2024;7(1):e2351166. doi:10.1001/jamanetworkopen.2023.51166
