Association of maternal education, neighborhood deprivation, and racial segregation with gestational age at birth by maternal race/ethnicity and United States Census region in the ECHO cohorts
BackgroundIn the United States, disparities in gestational age at birth by maternal race, ethnicity, and geography are theorized to be related, in part, to differences in individual- and neighborhood-level socioeconomic status (SES). Yet, few studies have examined their combined effects or whether a...
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Frontiers Media S.A.
2023-11-01
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| Online Access: | https://www.frontiersin.org/articles/10.3389/fpubh.2023.1165089/full |
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| author | Anne L. Dunlop Mohamad Burjak Lorraine T. Dean Akram N. Alshawabkeh Lyndsay A. Avalos Judy L. Aschner Judy L. Aschner Carrie V. Breton Mia A. Charifson Jose Cordero Dana Dabelea Viren D’Sa Cristiane S. Duarte Amy J. Elliott Stephanie M. Eick Assiamira Ferrara Raina N. Fichorova Jody M. Ganiban James E. Gern Monique M. Hedderson Julie B. Herbstman Alison E. Hipwell Kathi C. Huddleston Margaret Karagas Catherine Karr Jean M. Kerver Daphne Koinis-Mitchell Kristen Lyall Juliette Madan Carmen Marsit Cindy T. McEvoy John D. Meeker Emily Oken T. Michael O’Shea Amy M. Padula Sheela Sathyanarayana Susan Schantz Rebecca J. Schmidt Jessica Snowden Joseph B. Stanford Scott Weiss Robert O. Wright Robert O. Wright Rosalind J. Wright Rosalind J. Wright Xueying Zhang Xueying Zhang Monica McGrath |
| author_facet | Anne L. Dunlop Mohamad Burjak Lorraine T. Dean Akram N. Alshawabkeh Lyndsay A. Avalos Judy L. Aschner Judy L. Aschner Carrie V. Breton Mia A. Charifson Jose Cordero Dana Dabelea Viren D’Sa Cristiane S. Duarte Amy J. Elliott Stephanie M. Eick Assiamira Ferrara Raina N. Fichorova Jody M. Ganiban James E. Gern Monique M. Hedderson Julie B. Herbstman Alison E. Hipwell Kathi C. Huddleston Margaret Karagas Catherine Karr Jean M. Kerver Daphne Koinis-Mitchell Kristen Lyall Juliette Madan Carmen Marsit Cindy T. McEvoy John D. Meeker Emily Oken T. Michael O’Shea Amy M. Padula Sheela Sathyanarayana Susan Schantz Rebecca J. Schmidt Jessica Snowden Joseph B. Stanford Scott Weiss Robert O. Wright Robert O. Wright Rosalind J. Wright Rosalind J. Wright Xueying Zhang Xueying Zhang Monica McGrath |
| author_sort | Anne L. Dunlop |
| collection | DOAJ |
| description | BackgroundIn the United States, disparities in gestational age at birth by maternal race, ethnicity, and geography are theorized to be related, in part, to differences in individual- and neighborhood-level socioeconomic status (SES). Yet, few studies have examined their combined effects or whether associations vary by maternal race and ethnicity and United States Census region.MethodsWe assembled data from 34 cohorts in the Environmental influences on Child Health Outcomes (ECHO) program representing 10,304 participants who delivered a liveborn, singleton infant from 2000 through 2019. We investigated the combined associations of maternal education level, neighborhood deprivation index (NDI), and Index of Concentration at the Extremes for racial residential segregation (ICERace) on gestational weeks at birth using linear regression and on gestational age at birth categories (preterm, early term, post–late term relative to full term) using multinomial logistic regression.ResultsAfter adjustment for NDI and ICERace, gestational weeks at birth was significantly lower among those with a high school diploma or less (−0.31 weeks, 95% CI: −0.44, −0.18), and some college (−0.30 weeks, 95% CI: −0.42, −0.18) relative to a master’s degree or higher. Those with a high school diploma or less also had an increased odds of preterm (aOR 1.59, 95% CI: 1.20, 2.10) and early term birth (aOR 1.26, 95% CI: 1.05, 1.51). In adjusted models, NDI quartile and ICERace quartile were not associated with gestational weeks at birth. However, higher NDI quartile (most deprived) associated with an increased odds of early term and late term birth, and lower ICERace quartile (least racially privileged) associated with a decreased odds of late or post-term birth. When stratifying by region, gestational weeks at birth was lower among those with a high school education or less and some college only among those living in the Northeast or Midwest. When stratifying by race and ethnicity, gestational weeks at birth was lower among those with a high school education or less only for the non-Hispanic White category.ConclusionIn this study, maternal education was consistently associated with shorter duration of pregnancy and increased odds of preterm birth, including in models adjusted for NDI and ICERace. |
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| last_indexed | 2024-03-09T14:02:14Z |
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| spelling | doaj.art-b69c7a2977b94b9a920db82145f3fe0e2023-11-30T07:10:30ZengFrontiers Media S.A.Frontiers in Public Health2296-25652023-11-011110.3389/fpubh.2023.11650891165089Association of maternal education, neighborhood deprivation, and racial segregation with gestational age at birth by maternal race/ethnicity and United States Census region in the ECHO cohortsAnne L. Dunlop0Mohamad Burjak1Lorraine T. Dean2Akram N. Alshawabkeh3Lyndsay A. Avalos4Judy L. Aschner5Judy L. Aschner6Carrie V. Breton7Mia A. Charifson8Jose Cordero9Dana Dabelea10Viren D’Sa11Cristiane S. Duarte12Amy J. Elliott13Stephanie M. Eick14Assiamira Ferrara15Raina N. Fichorova16Jody M. Ganiban17James E. Gern18Monique M. Hedderson19Julie B. Herbstman20Alison E. Hipwell21Kathi C. Huddleston22Margaret Karagas23Catherine Karr24Jean M. Kerver25Daphne Koinis-Mitchell26Kristen Lyall27Juliette Madan28Carmen Marsit29Cindy T. McEvoy30John D. Meeker31Emily Oken32T. Michael O’Shea33Amy M. Padula34Sheela Sathyanarayana35Susan Schantz36Rebecca J. Schmidt37Jessica Snowden38Joseph B. Stanford39Scott Weiss40Robert O. Wright41Robert O. Wright42Rosalind J. Wright43Rosalind J. Wright44Xueying Zhang45Xueying Zhang46Monica McGrath47Department of Gynecology and Obstetrics, Emory University School of Medicine, Atlanta, GA, United StatesDepartment of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United StatesDepartment of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United StatesDepartment of Civil and Environmental Engineering, College of Engineering, Northeastern University, Boston, MA, United StatesDivision of Research, Kaiser Permanente Northern California, Oakland, CA, United StatesAlbert Einstein College of Medicine, Bronx, NY, United StatesHackensack Meridian School of Medicine, Nutley, NJ, United StatesDepartment of Population and Public Health Sciences, University of Southern California, Los Angeles, CA, United StatesDivision of Epidemiology, New York University Langone Health Grossman School of Medicine, New York, NY, United StatesDepartment of Epidemiology and Biostatistics, University of Georgia College of Public Health, Athens, GA, United States0Lifecourse Epidemiology of Adiposity and Diabetes Center, University of Colorado Anschutz Medical Campus, Aurora, CO, United States1Department of Pediatrics, Rhode Island Hospital and The Warren Alpert Medical School of Brown University, Providence, RI, United States2Division of Child and Adolescent Psychiatry, Columbia University-New York State Psychiatric Institute, New York, NY, United States3Avera Research Institute, Department of Pediatrics, University of South Dakota School of Medicine, Sioux Falls, SD, United States4Gangarosa Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, GA, United StatesDivision of Research, Kaiser Permanente Northern California, Oakland, CA, United States5Department of Obstetrics, Gynecology and Reproductive Biology, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, United States6Department of Psychological and Brain Sciences, George Washington University, Washington, DC, United States7Department of Pediatrics, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI, United StatesDivision of Research, Kaiser Permanente Northern California, Oakland, CA, United States8Department of Environmental Health Sciences, Columbia University Mailman School of Public Health, New York, NY, United States9Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, United States0College of Health and Human Services, George Mason University, Fairfax, VA, United States1Department of Epidemiology, Geisel School of Medicine at Dartmouth, Hanover, NH, United States2Departments of Pediatrics and Environmental and Occupational Health Sciences, University of Washington, Seattle, WA, United States3Departments of Epidemiology and Biostatistics and Pediatrics and Human Development, College of Human Medicine, Michigan State University, East Lansing, MI, United States1Department of Pediatrics, Rhode Island Hospital and The Warren Alpert Medical School of Brown University, Providence, RI, United States4AJ Drexel Autism Institute, Drexel University, Philadelphia, PA, United States5Department of Epidemiology, Pediatrics and Psychiatry, Geisel School of Medicine at Dartmouth, Hanover, NH, United States4Gangarosa Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, GA, United States6Department of Pediatrics, Oregon Health and Science University, Portland, OR, United States7Department of Environmental Health Sciences, University of Michigan School of Public Health, Ann Arbor, MI, United States8Division of Chronic Disease Research Across the Lifecourse, Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA, United States9Department of Pediatrics, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States0Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, San Francisco, CA, United States2Departments of Pediatrics and Environmental and Occupational Health Sciences, University of Washington, Seattle, WA, United States1Beckman Institute for Advanced Science and Technology, University of Illinois at Urbana-Champaign, Urbana, IL, United States2Department of Public Health Sciences, MIND Institute, University of California, Davis, Davis, CA, United States3Departments of Pediatrics and Biostatistics, University of Arkansas for Medical Sciences, Little Rock, AR, United States4Department of Family and Preventive Medicine, University of Utah School of Medicine, Salt Lake City, UT, United States5Department of Medicine, Harvard School of Medicine, Boston, MA, United States6Department of Pediatrics, The Kravis Children’s Hospital, Icahn School of Medicine at Mount Sinai, New York, NY, United States7Institute for Exposomic Research, Icahn School of Medicine at Mount Sinai, New York, NY, United States6Department of Pediatrics, The Kravis Children’s Hospital, Icahn School of Medicine at Mount Sinai, New York, NY, United States7Institute for Exposomic Research, Icahn School of Medicine at Mount Sinai, New York, NY, United States6Department of Pediatrics, The Kravis Children’s Hospital, Icahn School of Medicine at Mount Sinai, New York, NY, United States7Institute for Exposomic Research, Icahn School of Medicine at Mount Sinai, New York, NY, United StatesDepartment of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United StatesBackgroundIn the United States, disparities in gestational age at birth by maternal race, ethnicity, and geography are theorized to be related, in part, to differences in individual- and neighborhood-level socioeconomic status (SES). Yet, few studies have examined their combined effects or whether associations vary by maternal race and ethnicity and United States Census region.MethodsWe assembled data from 34 cohorts in the Environmental influences on Child Health Outcomes (ECHO) program representing 10,304 participants who delivered a liveborn, singleton infant from 2000 through 2019. We investigated the combined associations of maternal education level, neighborhood deprivation index (NDI), and Index of Concentration at the Extremes for racial residential segregation (ICERace) on gestational weeks at birth using linear regression and on gestational age at birth categories (preterm, early term, post–late term relative to full term) using multinomial logistic regression.ResultsAfter adjustment for NDI and ICERace, gestational weeks at birth was significantly lower among those with a high school diploma or less (−0.31 weeks, 95% CI: −0.44, −0.18), and some college (−0.30 weeks, 95% CI: −0.42, −0.18) relative to a master’s degree or higher. Those with a high school diploma or less also had an increased odds of preterm (aOR 1.59, 95% CI: 1.20, 2.10) and early term birth (aOR 1.26, 95% CI: 1.05, 1.51). In adjusted models, NDI quartile and ICERace quartile were not associated with gestational weeks at birth. However, higher NDI quartile (most deprived) associated with an increased odds of early term and late term birth, and lower ICERace quartile (least racially privileged) associated with a decreased odds of late or post-term birth. When stratifying by region, gestational weeks at birth was lower among those with a high school education or less and some college only among those living in the Northeast or Midwest. When stratifying by race and ethnicity, gestational weeks at birth was lower among those with a high school education or less only for the non-Hispanic White category.ConclusionIn this study, maternal education was consistently associated with shorter duration of pregnancy and increased odds of preterm birth, including in models adjusted for NDI and ICERace.https://www.frontiersin.org/articles/10.3389/fpubh.2023.1165089/fullgestational agepremature birthresidential segregationsocioeconomic statusracial and ethnic health disparitiesECHO program |
| spellingShingle | Anne L. Dunlop Mohamad Burjak Lorraine T. Dean Akram N. Alshawabkeh Lyndsay A. Avalos Judy L. Aschner Judy L. Aschner Carrie V. Breton Mia A. Charifson Jose Cordero Dana Dabelea Viren D’Sa Cristiane S. Duarte Amy J. Elliott Stephanie M. Eick Assiamira Ferrara Raina N. Fichorova Jody M. Ganiban James E. Gern Monique M. Hedderson Julie B. Herbstman Alison E. Hipwell Kathi C. Huddleston Margaret Karagas Catherine Karr Jean M. Kerver Daphne Koinis-Mitchell Kristen Lyall Juliette Madan Carmen Marsit Cindy T. McEvoy John D. Meeker Emily Oken T. Michael O’Shea Amy M. Padula Sheela Sathyanarayana Susan Schantz Rebecca J. Schmidt Jessica Snowden Joseph B. Stanford Scott Weiss Robert O. Wright Robert O. Wright Rosalind J. Wright Rosalind J. Wright Xueying Zhang Xueying Zhang Monica McGrath Association of maternal education, neighborhood deprivation, and racial segregation with gestational age at birth by maternal race/ethnicity and United States Census region in the ECHO cohorts Frontiers in Public Health gestational age premature birth residential segregation socioeconomic status racial and ethnic health disparities ECHO program |
| title | Association of maternal education, neighborhood deprivation, and racial segregation with gestational age at birth by maternal race/ethnicity and United States Census region in the ECHO cohorts |
| title_full | Association of maternal education, neighborhood deprivation, and racial segregation with gestational age at birth by maternal race/ethnicity and United States Census region in the ECHO cohorts |
| title_fullStr | Association of maternal education, neighborhood deprivation, and racial segregation with gestational age at birth by maternal race/ethnicity and United States Census region in the ECHO cohorts |
| title_full_unstemmed | Association of maternal education, neighborhood deprivation, and racial segregation with gestational age at birth by maternal race/ethnicity and United States Census region in the ECHO cohorts |
| title_short | Association of maternal education, neighborhood deprivation, and racial segregation with gestational age at birth by maternal race/ethnicity and United States Census region in the ECHO cohorts |
| title_sort | association of maternal education neighborhood deprivation and racial segregation with gestational age at birth by maternal race ethnicity and united states census region in the echo cohorts |
| topic | gestational age premature birth residential segregation socioeconomic status racial and ethnic health disparities ECHO program |
| url | https://www.frontiersin.org/articles/10.3389/fpubh.2023.1165089/full |
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