Preterm Birth Causes, Consequences, and Prevention (2007) / Chapter Skim
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4 Sociodemographic and Community Factors Contributing to Preterm Birth
4 Sociodemographic and Community Factors Contributing to Preterm Birth
Pages 124-147
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From page 124... ...
Examining the context of neighborhoods may be a promising avenue of exploration for explaining disparities in preterm birth because of clear patterns of residential segregation that result in unequal exposures to adverse neighborhood conditions. Although the evidence suggests that after adjustment for individual-level attributes, neighborhood conditions are independently and significantly associated with a risk of low birth weight, evidence regarding the relationship between 124
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From page 125... ...
The second section discusses the association between neighborhood conditions and the potential mechanisms through which the neighborhood context may influence reproductive outcomes. SOCIODEMOGRAPHIC FACTORS A number of maternal sociodemographic characteristics are associated with an increased risk for preterm birth.
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From page 126... ...
; the risk decreased with an increase in the age of the adolescent mothers. It is not known at present whether the increased risk of preterm birth among young adolescents is due to their biological immaturity or to an increased prevalence of other risk factors associated with their generally poor socioeconomic condition (Branum and Schoendorf, 2005; Mitchell and Bracken, 1990; Olausson et al., 2001; Scholl et al., 1992)
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From page 127... ...
birth cohorts. As shown in Table 4-1, preterm birth rates are higher for unmarried women than for married women across all racialethnic and age groups.
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From page 128... ...
128 TABLE 4-1 Preterm Birth Rates (percent) for Married and Unmarried Women, by Maternal Age and Race-Ethnicity, 1998 to 2000 Non-Hispanic African Non-Hispanic Asians-Pacific American Americans Whites Islanders Indians Hispanics Age Married Unmarried Married Unmarried Married Unmarried Married Unmarried Married Unmarried <20 13.7 17.6 10.4 11.5 12.4 14.3 10.3 12.8 10.6 12.7 20–34 13.7 16.7 7.9 10.8 8.3 11.9 10.2 12.0 9.1 11.0 16.2 22.9 8.6 14.0 9.9 14.0 13.4 16.0 11.5 14.2 ≥35 SOURCE: NCHS data for U.S.
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From page 129... ...
In 2003, the preterm birth rate was 13.9 percent for foreign-born blacks but 18.2 percent for U.S.-born African Americans (CDC, 2005i)
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From page 130... ...
Furthermore, socioeconomic condition does not confer equal protection across racial-ethnic groups, as shown in Table 4-2. For example, although within each racial-ethnic group the risk of preterm birth decreases with an increasing level of educational attainment, African American women with more than 16 years of education still have substantially higher preterm birth rates than non-Hispanic white women with less than 9 years of education.
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From page 131... ...
or interactions between race and behaviors, a few studies have concluded that the contributions of behavioral risk factors during pregnancy to racial disparities in birth outcomes such as preterm birth or low birth weight appear to be modest (Goldenberg et al., 1996a)
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From page 132... ...
Insofar as African American women may experience more stress in their daily lives than white women, it has been suggested that maternal stress may contribute to the disparities in preterm birth rates between African American and white women (James, 1993)
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From page 133... ...
A number of factors have been implicated, including maternal nutrition, cigarette smoking, substance use or abuse, work and physical activity, prenatal care, genitourinary tract infection, sexually transmitted diseases, psychological factors, and multiple gestations. A general discussion of these risk factors as they relate to preterm
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From page 134... ...
; therefore, the prepregnancy BMI cannot account for socioeconomic disparities in preterm birth rates. Recent evidence suggests that maternal obesity before pregnancy is associated with an increased risk for indicated preterm delivery but with a decreased risk for spontaneous preterm delivery (Hendler et al., 2005)
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From page 135... ...
Thus, psychosocial factors may prove an important mediator of socioeconomic disparities in preterm birth rates, but their etiologic links with preterm birth require further clarification. Although socioeconomic differences in multiple gestations have not been well studied, Kramer and colleagues speculate that indirect evidence of increased multiple births attributable to infertility treatment among women in high socioeconomic groups, coupled with the growing contribution of multiple births to the overall incidence of preterm birth, will narrow socioeconomic disparities (Kramer et al., 2000)
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From page 136... ...
However, as discussed in Chapter 3 and the previous section on sociodemographic factors, observational studies do not consistently demonstrate strong associations between the characteristics of the individual and the risk of preterm birth, nor do these individual-level characteristics explain the racial-ethnic differences in the rates of preterm birth. Some scholars argue that the study of discrete risk factors has led to a rather narrow, static view of perinatal risk assessment (Konte et al., 1988; Main and Gabbe, 1987)
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From page 137... ...
Neighborhood context may be a fruitful and salient avenue of exploration for explaining differences in preterm birth rates between African American and white women because of clear patterns of residential segregation that result in unequal exposures to adverse neighborhood conditions across racial-ethnic groups. Concentrated poverty and associated neighborhood disadvantages (including a lack of goods and services, health care facilities, and recreational opportunities; poor housing quality; and high crime rates)
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From page 138... ...
were more similar in poor neighborhoods than in more affluent areas. Lowrisk white women had much lower rates of low birth weight than low-risk African American women, no matter where they lived.
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From page 139... ...
They also found a number of significant interactions between neighborhood-level variables and individual-level risk factors for low birth weight. The protective effects of prenatal care, for example, were less strong in neighborhoods with high levels of unemployment, and the elevated risk of low birth weight among women with low levels of schooling was stronger in tracts with higher crime rates.
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From page 140... ...
Findings suggest that neighborhood SES was unrelated to the birth weights of children born to white women and U.S.-born Latinas, whereas it was related to a decrease in birth weight among blacks and Asians. Furthermore, foreign-born Latinas living in neighborhoods with high unemployment and poverty delivered infants of higher birth weights and had a lower risk of delivering a low birth weight infant.
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From page 141... ...
There are likely different mediators, moderators, and pathways to preterm birth than there are to low birth weight. Using preterm birth as a discrete outcome may not reveal effects.
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From page 142... ...
, for example, has argued that long-term exposure to socioeconomic disadvantage, including residence in socioeconomically disadvantaged neighborhoods, is detrimental to maternal reproductive health and is one of the factors that contributes to more adverse birth outcomes among African American women (O'Campo et al., 1997)
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From page 143... ...
found that the early initiation of prenatal care did not have the same beneficial effect for women living in disadvantaged neighborhoods in Baltimore, raising the possibility that prenatal care in deprived settings is unable to address various risks associated with adverse birth outcomes (Holzman et al., 1998; Kaufman et al., 1997)
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From page 144... ...
. In addition, adverse neighborhood conditions, such as crime, homelessness, and tax delinquency, were significantly associated with the risk of urogenital tract infection, one of the leading causes of preterm birth (Collins and David, 1997; Roberts, 1997)
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From page 145... ...
? If individual and contextual factors both influence outcomes, then models that exclude one or the other set of risk factors are likely to be poorly specified and lead to misinterpretation of the effects of both individual- and contextual-level factors.
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From page 146... ...
. Current research into the causes of the disparities commonly attempts to isolate the effect of a single risk factor, without accounting for the cooccurrence and potential interactions among multiple protective and risk factors (e.g., age and race or education and race)
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From page 147... ...
Numerous reports now show, however, that after adjustment for individual-level attributes, neighborhood conditions are in fact independently and significantly associated with a risk of delivering an infant with a low birth weight. Thus, because exposures to adverse neighborhood conditions are much more common for African American women than for their white counterparts, entire groups of women experience distress.
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