Abstract
Background/Objective: Preeclampsia is a hypertensive disorder associated with pregnancy that has a significant impact on maternal and neonatal health and has the potential to result in significant perinatal adverse outcomes. Maternal education has been proposed as a protective factor during pregnancy; however, its role in preeclamptic pregnancies remains unclear. This study aimed to explore the relationship between maternal education level, as defined by ISCED classification, and neonatal outcomes (birth weight, gestational age, and APGAR score) in pregnancies complicated by preeclampsia. Methods: A retrospective case-control analysis was conducted on 674 deliveries at a single tertiary center in Western Romania between January 2022 and August 2024. Neonatal outcomes, specifically birth weight, gestational age, and APGAR scores were studied and stratified into three ISCED-based maternal education subgroups. Statistical analyses, including ANOVA, chi-square tests, and logistic regression, were used to analyze the effect of maternal education, with confounders such as maternal age and chronic hypertension being controlled for. Results: Preeclampsia was associated with lower birth weight (p < 0.001), gestational age at birth (p < 0.001), and APGAR scores (p < 0.001) than the control group. Maternal level of education was associated with better neonatal outcomes in the preeclamptic group, with lower odds of fetal growth restriction (OR = 0.68, p = 0.03) and preterm birth; however, the effect was less pronounced in the control group. Conclusions: Maternal education partially mitigates the adverse effects of preeclampsia on neonatal well-being, birth weight, and gestational age at birth. These findings underscore the importance of incorporating maternal education into prenatal care programs to improve perinatal outcomes, with a special focus on high-risk pregnancies.