Maternal and Child Health Research Program

Advancing Applied MCH Research

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(SDAS) Inter-conceptional social mobility and racial disparities in adverse pregnancy

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Project Number: R40 MC 17180-01
Grantee: Emory University
Department/Center: School of Public Health / Epidemiology 1599-001-1BA
Project Date: 02/01/2010

Final Report

Submitted

Principal Investigator

Michael R. Kramer, PhD
Research Fellow
1518 Clifton Rd RM 238
Atlanta, GA  30322-4201
Phone: (404) 727-9818
Email: mkram02@sph.emory.edu

Age

  • Maternal
  • Prenatal
  • Infancy (0-12 months)

Race/Ethnicity

  • African American

Abstract

Very preterm birth and very low birthweight are the leading causes of racial disparities in infant mortality because black women in the US experience 2-3 times greater risk for these outcomes as compared to non-Hispanic white women. Eliminating these disparities is at the core of two MCHB research priorities. The long-term goal of the proposed study is to contribute to understanding and eliminating these determinants of racial disparities in poor pregnancy outcomes in the United States by testing whether inter-conceptional changes in lifecourse socioeconomic environment influence pregnancy risk. The aims of this project include description of the changes in social environments through the lifecourse for Georgia women, testing hypotheses about the effects of early life environments on subsequent pregnancy outcomes, and validating a novel approach to longitudinally measuring neighborhood environment. Women who live in materially deprived and socially chaotic environments have worse pregnancy outcomes than women living in more stable environments, net of individual risk factors. Toxic effects of the social environment may accumulate across the lifecourse rather than in the span of a single pregnancy; however most studies cannot test this hypothesis because the vast majority are cross-sectional in nature. This proposed secondary data analysis leverages two unique features of the Georgia Maternally-Linked Longitudinal Data Set (GA-MLLDS). The first is a shifted focus from pregnancy-centered to woman-centered information which results from the linking of all pregnancy outcomes through time for a given woman. This, combined with the presence of residential geocodes allowing measurement of neighborhood environment, permits us to test important lifecourse hypotheses. In addition to the GA-MLLDS, residential environmental data will be obtained from annually aggregated crime statistics and from census variables of poverty rate, educational attainment, housing quality, and employment. Commercially available, research-quality demographic projections at the census tract level for each year from 1994-2006 will be accessed to detail neighborhood change. Hypotheses will be tested with multi-level statistical models, and Bayesian measurement error models will be used to estimate any biasing effect resulting from the use of projected demographic variables. This research focuses on targeted objectives in Health People 2010 including the reduction of racial disparities in perinatal mortality, very preterm birth and very low birthweight. It also addresses recent calls by the Institute of Medicine to evaluate causes of adverse effects in light of interacting social, bio-behavioral, and demographic variables as they change across the lifecourse of women.

Publications

Listed is descending order by year published.

Kramer MR, Dunlop AL, Hogue CJ. Measuring Women's Cumulative Neighborhood Deprivation Exposure Using Longitudinally Linked Vital Records: A Method for Life Course MCH Research. Matern Child Health J. 2013 Feb 22. [Epub ahead of print] PubMed PMID: 23430295.

Kramer MR, Waller LA, Dunlop AL, Hogue CR. Housing transitions and low birth weight among low-income women: longitudinal study of the perinatal consequences of changing public housing policy. Am J Public Health.2012;102(12):2255-2261.

Keywords

Pregnancy, Neighborhood, Low Birthweight, Preterm, Preconception Health, Stress, Mortality, Health Disparities

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