142nd APHA Annual Meeting and Exposition

Annual Meeting Recordings are now available for purchase

Living in Disadvantaged Neighborhoods Increases the Risk for Having a Very Low Birth Weight Infant among Mothers Exposed to Preconception Stressful Life Events

142nd APHA Annual Meeting and Exposition (November 15 - November 19, 2014): http://www.apha.org/events-and-meetings/annual
Tuesday, November 18, 2014 : 12:30 PM - 12:50 PM

Whitney P. Witt, PhD, MPH , Truven Health Analytics, Bethesda, MD
Hyojun Park, MA , Department of Population Health Sciences, School of Medicine and Public Health, University of Wisconsin, Madison, WI
Lauren Wisk, PhD , Department of Population Medicine, Center for Child Health Care Studies, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA
Erika Cheng, PhD, MPA , Division of General Academic Pediatrics, Harvard Medical School and Massachusetts General Hospital for Children, Boston, MA
Kara Mandell, MA , Department of Population Health, University of Wisconsin-Madison, Madison, WI
Debanjana Chatterjee, MA , Population Health Sciences, University of Wisconsin Madison, Madison, WI
Background: Previous studies have demonstrated that exposure to preconception stressful life events (PSLEs) increases the risk for having adverse obstetric outcomes; however it is unclear whether neighborhood conditions influence this relationship. This study determined whether the effect of PSLEs on birth weight is stronger among women living in disadvantaged neighborhoods.

Methods: Data were from the Early Childhood Longitudinal Study, Birth Cohort (N=9,300). PSLEs included: death of parents, child or spouse, divorce or separation from partner, and fertility problems prior to conception. Factor analysis was used to create a neighborhood disadvantage index (NDI) using county-level data from the 2000 Census. The NDI was stratified into tertiles representing advantaged, middle advantaged, and disadvantaged neighborhoods. Multinomial logistic regressions stratified by NDI tertile estimated the odds of having very low (VLBW; less than 1,500 grams) or low (LBW; 1,500 to 2,499 grams) birth weight infants, controlling for confounders.

Principal Findings: Adjusted stratified analyses revealed a gradient in the associations between PSLEs and having a VLBW infant by NDI tertile; the association was strongest in disadvantaged neighborhoods (AOR=1.42, CI=1.10-1.85) followed by middle (AOR=1.35; CI=0.92-1.99) and advantaged (AOR=1.08; CI=0.59-1.96) neighborhoods. Neither PSLEs nor neighborhood conditions were associated with the increased odds of having LBW or HBW infants.

Conclusions:  Having a PSLE increased the risk of having VLBW infants among women living in disadvantaged neighborhoods.  To improve birth outcomes, population-level interventions should focus on not only reducing the deleterious effects of stressors, but also improving the health, financial, and educational well-being of neighborhoods.

Learning Areas:

Public health or related research
Social and behavioral sciences

Learning Objectives:
Describe how stressful life events prior to conception is associated with increased risks of adverse birth outcomes Identify the impact of neighborhood conditions on the association between PSLEs and birth outcomes Discuss programmatic and policy implications of our findings.

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I have been the principal or co-principal of multiple federally funded grants focusing on the maternal and child health. Among my scientific interests has been the application of the life course approach to understanding the social, behavioral, and psychological factors that contribute to human development and disparities in health and healthcare in women, children, and families.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.