Obese mothers with advanced education: Are their pregnancies protected from fetal demise?

Background: Maternal obesity and educational level have been investigated separately for their influence on feto-infant health. Maternal obesity has been associated with increased risk for infant mortality and adverse fetal growth outcomes, whereas higher maternal educational levels result in declining risk. However, the confluence of these factors in relation to stillbirth remains poorly understood. Methods: We utilized data from the Missouri maternally linked cohort data files for 1989-2005 to examine the risk for stillbirth based on obesity status and educational level (less than high school degree vs. high school degree or more). We used odds ratios to approximate relative risks. Results: Women with higher educational levels were more likely to be white, of advanced age (> 35 years), to be obese, and less likely to smoke during pregnancy (p<0.01). They also had higher rates of pregnancy-related complications, including insulin-dependent diabetes, chronic hypertension, pre-eclampsia, and placenta previa (p<0.01). Obese women of advanced education (AOR=1.30; 95% CI 1.19-1.41) and those who did not complete high school (AOR=1.26; 95% CI 1.08-1.47) were equally at elevated risk for stillbirth, as compared to non-obese women with advanced education. Black women with advanced education were twice as likely to experience stillbirth (AOR=1.98; 95% CI 1.80-2018) compared to their white counterparts. Conclusions: Obese women experience higher risk for stillbirth regardless of educational status. Additionally, a black-white disparity was evident. The interplay of multiple demographic and socio-cultural factors should be considered in the determination of the appropriate interconception strategies for women and their families.