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Open Access
CC BY 4.0 · Am J Perinatol
DOI: 10.1055/a-2717-3838
Original Article

The Association between Maternal Education Level and Infant Mortality Rates by Gestational Age among Black, White, and Hispanic Infants

Authors

  • J. Camille Goldman

    1   Heersink School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, United States

  • Mykaela J. Watt

    1   Heersink School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, United States

  • Sarah G. Trulove

    1   Heersink School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, United States

  • Rachel Tindal

    2   San Antonio Uniformed Services Health Education Consortium, San Antonio, Texas, United States

  • Vivek V. Shukla 

    3   Division of Neonatology, Department of Pediatrics, University of Alabama at Birmingham, Birmingham, Alabama, United States

  • Waldemar A. Carlo

    3   Division of Neonatology, Department of Pediatrics, University of Alabama at Birmingham, Birmingham, Alabama, United States

  • Colm P. Travers

    3   Division of Neonatology, Department of Pediatrics, University of Alabama at Birmingham, Birmingham, Alabama, United States

Funding Information This study was supported in part by grants from the National Institute of Health (C.P.T.: K23HL157618) and American Heart Association (C.P.T., V.V.S., and W.A.C.: 22HERNPMI985239; and V.V.S.: 23CDA1048106).
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Abstract

Objective

This study aimed to determine if maternal educational attainment is associated with racial/ethnic disparities in gestational age (GA)-specific infant mortality rate (IMR).

Study Design

Cohort study using data from the Centers for Disease Control and Prevention (CDC) WONDER expanded linked birth and infant death records database, 2017 to 2019. We included hospital-born infants from 22 to 41 weeks' gestation without major congenital anomalies. We compared GA-specific IMR by maternal race/ethnicity (Black, Hispanic, or White) and maternal education level.

Results

There were 9,356,130 eligible infants during the study period; 16.1% Black, 25.7% Hispanic, and 58.2% White. Black infants born at 23 and 24 weeks' gestation had lower IMR at all maternal education levels than White infants. Black infants from 36 to 40 weeks' gestation had higher IMR except at the lowest maternal education level. Hispanic infants born at 23 and 24 weeks' gestation had lower IMR than White infants across all education levels. At 36 to 40 weeks' gestation, Hispanic infants also had lower IMR except at the highest education level.

Conclusion

The association of maternal educational attainment on GA-specific IMR among late preterm and term infants differs by race and ethnicity. Disparities in IMR persist among Black infants despite educational attainment, while Hispanic infants had lower IMR at lower levels of educational attainment compared with White infants.

Key Points

  • The protective effect of maternal education on infant outcomes may vary by race/ethnicity.

  • Black late preterm and term infants have higher GA-specific IMRs than White infants, even with similar education levels.

  • Hispanic late preterm and term infants show lower mortality rates than White infants at lower education levels.

Keywords

infant - ethnicity - gestational age - infant mortality - educational status


Publication History

Received: 24 February 2025

Accepted: 02 October 2025

Article published online:
16 October 2025

© 2025. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/)

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