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(SDAS) Life Course Social Context and Disparities in Birth Outcomes


  • Prenatal
  • Perinatal/Infancy (0-12 months)


Infant mortality and its leading cause, preterm birth, vary dramatically by race; however reasons for observed disparities are poorly understood. Proximal measures of the social environment have limited ability to explain these disparities. Life course theory, which is helping to guide MCH program development emphasizes the importance of cumulative and longitudinal impacts of the social environment both within an individual's life span and across generations, yet no large-scale data exist to characterize social context across these time periods. This study will develop and characterize a population-based multi-ethnic cohort of women born in California with residence information from multiple points across the mother's life course; describe trajectories and cumulative exposure to social context from early childhood to each pregnancy and delivery; and evaluate the longitudinal and cumulative impact of life course social context on birth outcomes and on racial-ethnic disparities in birth outcomes. An inter-generational cohort of nearly 600,000 mothers will be derived from California's Biobank Linked Database, an existing client-based database of vital records linked to statewide newborn and prenatal screening records from 1982 to 2011. Address information from prenatal screening, newborn screening and birth records will be geocoded and linked to appropriate census tract-level data to develop patterns and cumulative measures of social context (poverty, deprivation, and racial/ethnic heterogeneity) from the time a mother was born, early childhood, and first and subsequent deliveries. Outcomes of the first and subsequent births will include preterm and very preterm birth, low birth weight, term low birthweight, and infant mortality. Effects of patterns and cumulative exposure to life course contextual factors on birth outcomes will be estimated using longitudinal models accounting for time-dependent confounding. Analyses will be stratified by maternal race ethnicity, with Mexican Hispanic women further described by generation in the U.S. Because the cohort is restricted to mothers born in California since 1982, the cohort will be compared to less restricted birth populations, and analyses using proximal and inter-conception measures replicated in a 5-year birth cohort delivering during the same time period. The results will further our understanding of the potential impact of inter-conceptional and early-life interventions on perinatal health. This research addresses MCHB Strategic Research Issues #II, supporting efforts to eliminate health disparities, and #IV, promoting the healthy development of MCH populations. Strengthening the MCH life course knowledge base and further developing longitudinally linked data systems are in line with integration of the life course perspective into MCHB's strategic directions.


Listed is descending order by year published.

Pearl M, Ahern J, Hubbard A, et al. Life-course neighbourhood opportunity and racial-ethnic disparities in risk of preterm birth. Paediatric and perinatal epidemiology. 2018;32(5):412-419

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