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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

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  • 06/25/2025
Type of Material
Authors
    Anne Lang Dunlop, Emory UniversityMohamad Burjak, Johns Hopkins UniversityLorraine T. Dean, Johns Hopkins UniversityAkram N. Alshawabkeh, Northeastern UniversityLyndsay A. Avalos, Kaiser Permanente Northern CaliforniaJudy L. Aschner, Albert Einstein College of MedicineCarrie V. Breton, University of Southern CaliforniaMia A. Charifson, New York UniversityJose Cordero, University of GeorgiaDana Dabelea, University of Colorado, AuroraViren D'Sa, Brown UniversityCristiane S. Duarte, Columbia UniversityAmy J. Elliott, University of South Dakota, Sioux FallsStephanie M. Eick, Emory UniversityAssiamira Ferrara, Kaiser Permanente Northern CaliforniaRaina N. Fichorova, Harvard UniversityJody M. Ganiban, George Washington UniversityJames E. Gern, University of Wisconsin-MadisonMonique M. Hedderson, Kaiser Permanente Northern CaliforniaJulie B. Herbstman, Columbia UniversityAlison E. Hipwell, University if PittsburghKathi C. Huddleston, George Mason UniversityMargaret Karagas, Dartmouth CollegeCatherine Karr, University of Washington, SeattleJean M. Kerver, Michigan State University, East LansingDaphne Koinis-Mitchell, Brown UniversityKristen Lyall, Drexel UniversityJuliette Madan, Dartmouth CollegeCarmen Marsit, Emory UniversityCindy T. McEvoy, Oregon Health and Science UniversityJohn D. Meeker, University of Michigan, Ann ArborEmily Oken, Harvard UniversityT. michael O'Shea, University of North Carolina, Chapel HillAmy M. Padula, University of California, San FranciscoSheela Sathyanarayana, University of Washington, SeattleSusan Schantz, University of Illinois, Urbana-ChampaignRebecca J. Schmidt, University of California, DavisJessica Snowden, University of Arkansas, Little RockJoseph B. Stanford, University of Utah, Salt Lake CityScott Weiss, Harvard UniversityRobert O. Wright, Icahn School of Medicine at Mount SinaiRosalind J. Wright, Icahn School of Medicine at Mount SinaiXueying Zhang, Icahn School of Medicine at Mount SinaiMonica McGrath, Johns Hopkins University
Language
  • English
Date
  • 2023-11-30
Publisher
  • Frontiers
Publication Version
Copyright Statement
  • © 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.
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Final Published Version (URL)
Title of Journal or Parent Work
Volume
  • 11
Start Page
  • 1165089
Grant/Funding Information
  • Research reported in this publication was supported by the Environmental influences on Child Health Outcomes (ECHO) program, Office of the Director, National Institutes of Health, under Award Numbers U2COD023375 (Coordinating Center), U24OD023382 (Data Analysis Center, Jacobson), U24OD023319 with co-funding from the Office of Behavioral and Social Science Research (PRO Core), UH3OD023251 (Alshawabkeh), UH3OD023320 (Aschner), UH3OD023248 (Dabelea), UH3OD023313 (Koinis-Mitchell), UH3OD023328 (Duarte), UH3OD023318 (Dunlop), UH3OD023279 (Elliott), UH3OD023289 (Ferrara), UH3OD023282 (Gern), UH3OD023287 (Breton), UH3OD023244 (Hipwell), UH3OD023275 (Karagas), UH3OD023271 (Karr), UH3OD023347 (Lester), UH3OD023268 (Weiss), UH3OD023288 (McEvoy), UH3OD023342 (Lyall), UH3OD023349 (O’Connor), UH3OD023286 (Oken), UH3OD023348 (O’Shea), UH3OD023285 (Kerver), UH3OD023290 (Herbstman), UH3OD023272 (Schantz), UH3OD023249 (Stanford), UH3OD023305 (Trasande), U24OD024957 (Snowden), and UH3OD023337 (Wright).
Supplemental Material (URL)
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 (ICERace) 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 ICERace, 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 ICERace 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 ICERace 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 ICERace.
Author Notes
Keywords
Research Categories
  • Health Sciences, Obstetrics and Gynecology
  • Health Sciences, Public Health
  • Sociology, Ethnic and Racial Studies

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