The higher the educational level of the first-time mother, the lower the fetal and post-neonatal but not the neonatal mortality in Belgium (Flanders).

Objective: To assess, in a homogenous population of primiparous women, how fetal and infant (=first year of life) mortality varied by the mothers' level of education.

Study Design: We conducted an observational study in Flanders (Northern Belgium) involving 170,948 primiparous women who delivered in Flanders during the period 1999-2006, and their 174,495 babies. We linked the maternal education (3 levels) with a series of obstetrical and perinatal events, with special emphasis on fetal and infant death. A logistic regression analysis was performed to adjust for confounders.

Results: The incidence of fetal (0.21% - high level of education; 0.35% - medium level; 0.84% - low level) and infant mortality (0.32%; 0.41%; 0.70%, respectively), followed an inverse maternal educational gradient: higher with a lower level of education. However, neonatal death (0-27 days) was independent of the educational level of the mother. The age of the woman at delivery, the use of assisted reproductive technology and the incidence of twin birth increased while the rates of preterm birth (7.7% - high level; 8.9% - medium level; 10% - low level) and low birth weight (7.2%; 9.5%; 11.8%, respectively) decreased with the mother's educational level.

Conclusion: Perinatal and obstetrical outcome differ according to the level of the education of the mother, which is a determinant of the incidence of fetal and post-neonatal death but not of early and late neonatal death (0-27 days).