Maternal Education as a Predictor of Pregnancy Outcomes: A Retrospective Cohort Study from a Gambian Hospital

Abstract

Adverse pregnancy outcomes such as low birth weight and preterm birth remain significant public health challenges in sub-Saharan Africa, disproportionately affecting low-resource settings like The Gambia. Maternal education is a key social determinant of health, yet its specific impact in The Gambia is not well-documented. This study examines the association between maternal education and pregnancy outcomes among women delivering at Edward Francis Small Teaching Hospital (EFSTH) in The Gambia. Using a hospital-based retrospective cohort design, data from 1,600 women aged 15–49 years with singleton live births (December 2021–January 2022) were analyzed. Results revealed a dose-response relationship, with higher maternal education significantly associated with reduced adverse outcomes. Maternal education levels were categorized as none (28.1%), primary (42.3%), secondary (24.6%), or higher (5.0%). Outcomes included low birth weight (<2.5 kg), preterm birth (<37 weeks), neonatal mortality, and Apgar scores (<7 at 5 minutes). Mothers with no formal education had the highest rates of adverse outcomes, including low birth weight (32.4%), preterm birth (19.8%), neonatal mortality (6.5%), and low Apgar scores (14.2%). In contrast, mothers with higher education exhibited the lowest rates (6.2%, 5.0%, 1.0%, and 2.0%, respectively). Adjusted analyses confirmed these findings: secondary education reduced odds of low birth weight by 45% (aOR: 0.55, 95% CI: 0.42–0.72), preterm birth by 50% (aOR: 0.50, 95% CI: 0.35–0.71), and low Apgar scores by 49% (aOR: 0.51, 95% CI: 0.38–0.69), with even stronger protective effects for tertiary education. Subgroup analyses highlighted greater benefits in rural areas and among women with fewer antenatal visits. The study underscores maternal education as a critical predictor of improved pregnancy outcomes in low-resource settings, advocating for integrated interventions that combine educational advancement with healthcare strengthening to reduce maternal and neonatal disparities.