Office of Epidemiology and Research, Division of Research

Advancing Applied MCH Research

(SDAS) Impact of Preconception and Contextual Factors on Birth and Child Health Outcomes

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Project Number: R40MC23625
Grantee: Board of Regents of the University of Wisconsin System
Department/Center: Population Health Sciences Medicine & Public Health
Project Date: 04/01/2012

Final Report


Principal Investigator

Whitney P. Witt, PhD
Assistant Professor
610 Walnut St.
Madison, WI  53715
Phone: 608-265-6290


  • Women/Maternal
  • Prenatal
  • Perinatal/Infancy (0-12 months)
  • Toddlerhood (13-35 months)


Pregnancy complications and poor birth outcomes can affect the survival and long-term health of children. The preconception period may represent an opportunity to intervene and improve outcomes; however little is known about women's life events and health prior to pregnancy as predictors of such outcomes. Moreover, it is unknown if neighborhood-level factors impact these preconception effects on obstetric and child health outcomes. This proposed study aims to determine if and to what extent women's stressful life events, preconception health behaviors, and neighborhood health and disadvantage influence pregnancy, birth, and child health outcomes using a nationally representative, population-based sample. The objectives of the proposed study are to: 1) determine whether preconception stressful life events are associated with adverse obstetric outcomes and child health at 9 months and 2 years of age; 2) determine if and to what extent preconception health behaviors mediate the relationship between preconception stressful life events and adverse obstetric and child health outcomes; and 3) determine whether the effect of preconception stressful life events and health behaviors on outcomes is stronger in disadvantaged or unhealthy neighborhoods. Data are from the Early Childhood Longitudinal Study, Birth Cohort (ECLS-B), a nationally representative cohort of 10,688 children born in 2001 and their parents. Data are from interviews, self-administered questionnaires, direct observations, and birth certificates. Dependent variables will include: pregnancy and labor complications, birth outcomes, and child health. Independent variables will include: preconception stressful life events, preconception health behaviors, and measures of neighborhood health and disadvantage. Data analyses will include linear, logistic, and multilevel models, and will control for individual sociodemographic covariates (e.g. age, race/ethnicity, SES). This study is innovative in taking a life course and contextual approach to understanding the trans-generational development of poor birth and child health outcomes. Research findings have important clinical and public health implications. Our findings will help identify women at risk for poor outcomes and develop interventions that will improve the health of women before they become pregnant. Additionally, this research will assist in developing effective public health interventions at the neighborhood level. By examining the contextual effects (i.e. neighborhood) on outcomes and identifying vulnerable subpopulations, this study will reduce health disparities, which is central to MCHB Strategic Research Issue II to "eliminate health disparities." We also address MCHB Strategic Research Issue IV to "promote the healthy development of MCH populations," as we will study the factors associated with preventive health behaviors of women in the preconception period and the impact on birth and child outcomes.


Listed is descending order by year published.

Witt WP, Wisk LE, Cheng ER, Mandell K, Chatterjee D, Wakeel F, Godecker AL, Zarak D. Determinants of cesarean delivery in the US: A Lifecourse approach. Matern Child Health J. 2015 Jan;19(1)84-93. Epub 2014 Apr 26. PMID: 24770955

Witt WP, Cheng ER, Wisk LE, Litzelman K, Chatterjee D, Mandell K, Wakeel F. Maternal Stressful Life Events Prior to Conception and the Impact on Infant Birth Weight in the United States. Am J Public Health. 2013 Dec 19. [Epub ahead of print] PubMed PMID: 24354829.

Witt WP, Cheng ER, Wisk LE, Litzelman K, Chatterjee D, Mandell K, Wakeel F. Preterm Birth in the United States: The Impact of Stressful Life Events Prior to Conception and Maternal Age. Am J Public Health. 2013 Dec 19. [Epub ahead of print] PubMed PMID: 24354830.


Preconception Health, Stress, Pregnancy, Labor & Delivery, Preterm, Low Birthweight, Health Disparities, Neighborhood

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