. 2023 Nov 30:11:1165089.

doi: 10.3389/fpubh.2023.1165089. eCollection 2023.

Association of maternal education, neighborhood deprivation, and racial segregation with gestational age at birth by maternal race/ethnicity and United States Census region in the ECHO cohorts

Anne L Dunlop¹, Mohamad Burjak², Lorraine T Dean², Akram N Alshawabkeh³, Lyndsay A Avalos⁴, Judy L Aschner^{5

6}, Carrie V Breton⁷, Mia A Charifson⁸, Jose Cordero⁹, Dana Dabelea¹⁰, Viren D'Sa¹¹, Cristiane S Duarte¹², Amy J Elliott¹³, Stephanie M Eick¹⁴, Assiamira Ferrara⁴, Raina N Fichorova¹⁵, Jody M Ganiban¹⁶, James E Gern¹⁷, Monique M Hedderson⁴, Julie B Herbstman¹⁸, Alison E Hipwell¹⁹, Kathi C Huddleston²⁰, Margaret Karagas²¹, Catherine Karr²², Jean M Kerver²³, Daphne Koinis-Mitchell¹¹, Kristen Lyall²⁴, Juliette Madan²⁵, Carmen Marsit¹⁴, Cindy T McEvoy²⁶, John D Meeker²⁷, Emily Oken²⁸, T Michael O'Shea²⁹, Amy M Padula³⁰, Sheela Sathyanarayana²², Susan Schantz³¹, Rebecca J Schmidt³², Jessica Snowden³³, Joseph B Stanford³⁴, Scott Weiss³⁵, Robert O Wright^{36

37}, Rosalind J Wright^{36

37}, Xueying Zhang^{36

37}, Monica McGrath²

Affiliations

¹ Department of Gynecology and Obstetrics, Emory University School of Medicine, Atlanta, GA, United States.
² Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States.
³ Department of Civil and Environmental Engineering, College of Engineering, Northeastern University, Boston, MA, United States.
⁴ Division of Research, Kaiser Permanente Northern California, Oakland, CA, United States.
⁵ Albert Einstein College of Medicine, Bronx, NY, United States.
⁶ Hackensack Meridian School of Medicine, Nutley, NJ, United States.
⁷ Department of Population and Public Health Sciences, University of Southern California, Los Angeles, CA, United States.
⁸ Division of Epidemiology, New York University Langone Health Grossman School of Medicine, New York, NY, United States.
⁹ Department of Epidemiology and Biostatistics, University of Georgia College of Public Health, Athens, GA, United States.
¹⁰ Lifecourse Epidemiology of Adiposity and Diabetes Center, University of Colorado Anschutz Medical Campus, Aurora, CO, United States.
¹¹ Department of Pediatrics, Rhode Island Hospital and The Warren Alpert Medical School of Brown University, Providence, RI, United States.
¹² Division of Child and Adolescent Psychiatry, Columbia University-New York State Psychiatric Institute, New York, NY, United States.
¹³ Avera Research Institute, Department of Pediatrics, University of South Dakota School of Medicine, Sioux Falls, SD, United States.
¹⁴ Gangarosa Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, GA, United States.
¹⁵ Department of Obstetrics, Gynecology and Reproductive Biology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United States.
¹⁶ Department of Psychological and Brain Sciences, George Washington University, Washington, DC, United States.
¹⁷ Department of Pediatrics, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI, United States.
¹⁸ Department of Environmental Health Sciences, Columbia University Mailman School of Public Health, New York, NY, United States.
¹⁹ Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, United States.
²⁰ College of Health and Human Services, George Mason University, Fairfax, VA, United States.
²¹ Department of Epidemiology, Geisel School of Medicine at Dartmouth, Hanover, NH, United States.
²² Departments of Pediatrics and Environmental and Occupational Health Sciences, University of Washington, Seattle, WA, United States.
²³ Departments of Epidemiology and Biostatistics and Pediatrics and Human Development, College of Human Medicine, Michigan State University, East Lansing, MI, United States.
²⁴ AJ Drexel Autism Institute, Drexel University, Philadelphia, PA, United States.
²⁵ Department of Epidemiology, Pediatrics and Psychiatry, Geisel School of Medicine at Dartmouth, Hanover, NH, United States.
²⁶ Department of Pediatrics, Oregon Health and Science University, Portland, OR, United States.
²⁷ Department of Environmental Health Sciences, University of Michigan School of Public Health, Ann Arbor, MI, United States.
²⁸ Division of Chronic Disease Research Across the Lifecourse, Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA, United States.
²⁹ Department of Pediatrics, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States.
³⁰ Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, San Francisco, CA, United States.
³¹ Beckman Institute for Advanced Science and Technology, University of Illinois at Urbana-Champaign, Urbana, IL, United States.
³² Department of Public Health Sciences, MIND Institute, University of California, Davis, Davis, CA, United States.
³³ Departments of Pediatrics and Biostatistics, University of Arkansas for Medical Sciences, Little Rock, AR, United States.
³⁴ Department of Family and Preventive Medicine, University of Utah School of Medicine, Salt Lake City, UT, United States.
³⁵ Department of Medicine, Harvard School of Medicine, Boston, MA, United States.
³⁶ Department of Pediatrics, The Kravis Children's Hospital, Icahn School of Medicine at Mount Sinai, New York, NY, United States.
³⁷ Institute for Exposomic Research, Icahn School of Medicine at Mount Sinai, New York, NY, United States.

PMID: 38098826
PMCID: PMC10719953
DOI: 10.3389/fpubh.2023.1165089

Association of maternal education, neighborhood deprivation, and racial segregation with gestational age at birth by maternal race/ethnicity and United States Census region in the ECHO cohorts

Anne L Dunlop et al. Front Public Health. 2023.

. 2023 Nov 30:11:1165089.

doi: 10.3389/fpubh.2023.1165089. eCollection 2023.

Authors

Affiliations

¹ Department of Gynecology and Obstetrics, Emory University School of Medicine, Atlanta, GA, United States.
² Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States.
³ Department of Civil and Environmental Engineering, College of Engineering, Northeastern University, Boston, MA, United States.
⁴ Division of Research, Kaiser Permanente Northern California, Oakland, CA, United States.
⁵ Albert Einstein College of Medicine, Bronx, NY, United States.
⁶ Hackensack Meridian School of Medicine, Nutley, NJ, United States.
⁷ Department of Population and Public Health Sciences, University of Southern California, Los Angeles, CA, United States.
⁸ Division of Epidemiology, New York University Langone Health Grossman School of Medicine, New York, NY, United States.
⁹ Department of Epidemiology and Biostatistics, University of Georgia College of Public Health, Athens, GA, United States.
¹⁰ Lifecourse Epidemiology of Adiposity and Diabetes Center, University of Colorado Anschutz Medical Campus, Aurora, CO, United States.
¹¹ Department of Pediatrics, Rhode Island Hospital and The Warren Alpert Medical School of Brown University, Providence, RI, United States.
¹² Division of Child and Adolescent Psychiatry, Columbia University-New York State Psychiatric Institute, New York, NY, United States.
¹³ Avera Research Institute, Department of Pediatrics, University of South Dakota School of Medicine, Sioux Falls, SD, United States.
¹⁴ Gangarosa Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, GA, United States.
¹⁵ Department of Obstetrics, Gynecology and Reproductive Biology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United States.
¹⁶ Department of Psychological and Brain Sciences, George Washington University, Washington, DC, United States.
¹⁷ Department of Pediatrics, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI, United States.
¹⁸ Department of Environmental Health Sciences, Columbia University Mailman School of Public Health, New York, NY, United States.
¹⁹ Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, United States.
²⁰ College of Health and Human Services, George Mason University, Fairfax, VA, United States.
²¹ Department of Epidemiology, Geisel School of Medicine at Dartmouth, Hanover, NH, United States.
²² Departments of Pediatrics and Environmental and Occupational Health Sciences, University of Washington, Seattle, WA, United States.
²³ Departments of Epidemiology and Biostatistics and Pediatrics and Human Development, College of Human Medicine, Michigan State University, East Lansing, MI, United States.
²⁴ AJ Drexel Autism Institute, Drexel University, Philadelphia, PA, United States.
²⁵ Department of Epidemiology, Pediatrics and Psychiatry, Geisel School of Medicine at Dartmouth, Hanover, NH, United States.
²⁶ Department of Pediatrics, Oregon Health and Science University, Portland, OR, United States.
²⁷ Department of Environmental Health Sciences, University of Michigan School of Public Health, Ann Arbor, MI, United States.
²⁸ Division of Chronic Disease Research Across the Lifecourse, Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA, United States.
²⁹ Department of Pediatrics, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States.
³⁰ Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, San Francisco, CA, United States.
³¹ Beckman Institute for Advanced Science and Technology, University of Illinois at Urbana-Champaign, Urbana, IL, United States.
³² Department of Public Health Sciences, MIND Institute, University of California, Davis, Davis, CA, United States.
³³ Departments of Pediatrics and Biostatistics, University of Arkansas for Medical Sciences, Little Rock, AR, United States.
³⁴ Department of Family and Preventive Medicine, University of Utah School of Medicine, Salt Lake City, UT, United States.
³⁵ Department of Medicine, Harvard School of Medicine, Boston, MA, United States.
³⁶ Department of Pediatrics, The Kravis Children's Hospital, Icahn School of Medicine at Mount Sinai, New York, NY, United States.
³⁷ Institute for Exposomic Research, Icahn School of Medicine at Mount Sinai, New York, NY, United States.

PMID: 38098826
PMCID: PMC10719953
DOI: 10.3389/fpubh.2023.1165089

Abstract

Background: In the United States, disparities in gestational age at birth by maternal race, ethnicity, and geography are theorized to be related, in part, to differences in individual- and neighborhood-level socioeconomic status (SES). Yet, few studies have examined their combined effects or whether associations vary by maternal race and ethnicity and United States Census region.

Methods: We assembled data from 34 cohorts in the Environmental influences on Child Health Outcomes (ECHO) program representing 10,304 participants who delivered a liveborn, singleton infant from 2000 through 2019. We investigated the combined associations of maternal education level, neighborhood deprivation index (NDI), and Index of Concentration at the Extremes for racial residential segregation (ICE_Race) on gestational weeks at birth using linear regression and on gestational age at birth categories (preterm, early term, post-late term relative to full term) using multinomial logistic regression.

Results: After adjustment for NDI and ICE_Race, gestational weeks at birth was significantly lower among those with a high school diploma or less (-0.31 weeks, 95% CI: -0.44, -0.18), and some college (-0.30 weeks, 95% CI: -0.42, -0.18) relative to a master's degree or higher. Those with a high school diploma or less also had an increased odds of preterm (aOR 1.59, 95% CI: 1.20, 2.10) and early term birth (aOR 1.26, 95% CI: 1.05, 1.51). In adjusted models, NDI quartile and ICE_Race quartile were not associated with gestational weeks at birth. However, higher NDI quartile (most deprived) associated with an increased odds of early term and late term birth, and lower ICE_Race quartile (least racially privileged) associated with a decreased odds of late or post-term birth. When stratifying by region, gestational weeks at birth was lower among those with a high school education or less and some college only among those living in the Northeast or Midwest. When stratifying by race and ethnicity, gestational weeks at birth was lower among those with a high school education or less only for the non-Hispanic White category.

Conclusion: In this study, maternal education was consistently associated with shorter duration of pregnancy and increased odds of preterm birth, including in models adjusted for NDI and ICE_Race.

Keywords: ECHO program; gestational age; premature birth; racial and ethnic health disparities; residential segregation; socioeconomic status.

Copyright © 2023 Dunlop, Burjak, Dean, Alshawabkeh, Avalos, Aschner, Breton, Charifson, Cordero, Dabelea, D’Sa, Duarte, Elliott, Eick, Ferrara, Fichorova, Ganiban, Gern, Hedderson, Herbstman, Hipwell, Huddleston, Karagas, Karr, Kerver, Koinis-Mitchell, Lyall, Madan, Marsit, McEvoy, Meeker, Oken, O’Shea, Padula, Sathyanarayana, Schantz, Schmidt, Snowden, Stanford, Weiss, Wright, Wright, Zhang and McGrath.

PubMed Disclaimer

Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

**Figure 1**
Derivation of the study sample from ECHO cohort data.

**Figure 2**
Prenatal residential census tracts and regions for the ECHO study sample.

**Figure 3**
Adjusted odds ratios for gestational age at birth categories (full-term birth as referent category) among singleton births from 2000 to 2019 in the ECHO cohorts–secondary study population.

See this image and copyright information in PMC

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Association of maternal education, neighborhood deprivation, and racial segregation with gestational age at birth by maternal race/ethnicity and United States Census region in the ECHO cohorts

Affiliations

Association of maternal education, neighborhood deprivation, and racial segregation with gestational age at birth by maternal race/ethnicity and United States Census region in the ECHO cohorts

Authors

Affiliations

Abstract

Conflict of interest statement

Figures

References

Publication types

MeSH terms

Grants and funding

LinkOut - more resources

Full Text Sources