Racial and geographic variation in effects of maternal education and neighborhood-level measures of socioeconomic status on gestational age at birth: Findings from the ECHO cohorts

• Type of Material: Article
• Authors: Anne Dunlop, Emory University; Alicynne G Essalmi, Michigan State University; Lyndsay Alvalos, Kaiser Permanente Northern Calif; Carrie Breton, University of Southern California; Carlos A Camargo, Harvard University; Whitney J Cowell, Icahn Sch Med Mt Sinai; Dana Dabelea, University of Colorado; Stephen R Dager, University of Washington; Cristiane Duarte, Columbia University; Amy Elliott, Avera Research Institute; Raina Fichorova, Brigham and Women’s Hospital; J Gern, University of Wisconsin, Madison; Monique M Hedderson, Kaiser Permanente Northern Calif; Elizabeth H Thepaksorn, University of California San Francisco; Kathi Huddleston, George Mason University; Margaret R Karagas, Geisel School of Medicine at Dartmouth; Ken Kleinman, University of Massachusetts Amherst; Leslie Leve, University of Oregon; Ximin Li, Johns Hopkins Bloomberg Sch Publ Hlth; Yijun Li, Johns Hopkins Bloomberg Sch Publ Hlth; Augusto Litonjua, University of Rochester; Yunin LudenaRodriguez, University of California Davis; Juliette C Madan, Dartmouth Hitchcock Medical Center, Hanover; Julio M Nino, Maternal and Fetal Medicine, Atrium Health; Cynthia McEvoy, Oregon Health & Science University; Thomas G O'Connor, University of Rochester; Amy M Padula, University of California San Francisco; Nigel Paneth, Michigan State University; Frederica Perera, Columbia University; Sheela Sathyanarayana, University of Washington; Rebecca J Schmidt, University of California Davis; Robert T Schultz, University of Pennsylvania; Jessica Snowden, University of Arkansas Medical Sciences; Joseph B Stanford, University of Utah; Leonardo Trasande, New York University Grossman School of Medicine; Heather E Volk, Johns Hopkins Bloomberg Sch Publ Hlth; William Wheaton, RTI International; Rosalind J Wright, Icahn School of Medicine at Mount Sinai, New York; Monica McGrath, Johns Hopkins Bloomberg School of Public Health
• Language: English
• Date: 2021-01-08
• Publisher: PUBLIC LIBRARY SCIENCE
• Publication Version: Final Published Version
• Copyright Statement: © 2021 Dunlop et al
• License: Creative Commons Attribution 4.0 International
• Final Published Version (URL): http://dx.doi.org/10.1371/journal.pone.0245064
• Title of Journal or Parent Work: PLOS ONE
• Volume: 16
• Issue: 1
• Start Page: e0245064
• End Page: e0245064
• Grant/Funding Information: Please see the supporting information file S1 Funding for a complete list of all funding sources and grant numbers.
• Keywords: MULTIPLE IMPUTATION; US; RISK; BIRTH; PRETERM BIRTH; CONTEXT; CHILD HEALTH OUTCOMES; Multidisciplinary Sciences; Science & Technology - Other Topics; AIR-POLLUTION; Science & Technology; MATERNAL; ETHNIC DISPARITIES; ENVIRONMENTAL-INFLUENCES; STRESS
• Research Categories: Health Sciences, Public Health; Health Sciences, Epidemiology

Abstract

Preterm birth occurs at excessively high and disparate rates in the United States. In 2016, the National Institutes of Health (NIH) launched the Environmental influences on Child Health Outcomes (ECHO) program to investigate the influence of early life exposures on child health. Extant data from the ECHO cohorts provides the opportunity to examine racial and geographic variation in effects of individual- and neighborhood-level markers of socioeconomic status (SES) on gestational age at birth. The objective of this study was to examine the association between individual-level (maternal education) and neighborhood-level markers of SES and gestational age at birth, stratifying by maternal race/ethnicity, and whether any such associations are modified by US geographic region. Twenty-six ECHO cohorts representing 25,526 mother-infant pairs contributed to this disseminated meta-analysis that investigated the effect of maternal prenatal level of education (high school diploma, GED, or less; some college, associate's degree, vocational or technical training [reference category]; bachelor's degree, graduate school, or professional degree) and neighborhood-level markers of SES (census tract [CT] urbanicity, percentage of black population in CT, percentage of population below the federal poverty level in CT) on gestational age at birth (categorized as preterm, early term, full term [the reference category], late, and post term) according to maternal race/ethnicity and US region. Multinomial logistic regression was used to estimate odds ratios (OR) and 95% confidence intervals (CIs). Cohort-specific results were meta-analyzed using a random effects model. For women overall, a bachelor's degree or above, compared with some college, was associated with a significantly decreased odds of preterm birth (aOR 0.72; 95% CI: 0.61-0.86), whereas a high school education or less was associated with an increased odds of early term birth (aOR 1.10, 95% CI: 1.00-1.21). When stratifying by maternal race/ethnicity, there were no significant associations between maternal education and gestational age at birth among women of racial/ethnic groups other than non-Hispanic white. Among non-Hispanic white women, a bachelor's degree or above was likewise associated with a significantly decreased odds of preterm birth (aOR 0.74 (95% CI: 0.58, 0.94) as well as a decreased odds of early term birth (aOR 0.84 (95% CI: 0.74, 0.95). The association between maternal education and gestational age at birth varied according to US region, with higher levels of maternal education associated with a significantly decreased odds of preterm birth in the Midwest and South but not in the Northeast and West. Non-Hispanic white women residing in rural compared to urban CTs had an increased odds of preterm birth; the ability to detect associations between neighborhood-level measures of SES and gestational age for other race/ethnic groups was limited due to small sample sizes within select strata. Interventions that promote higher educational attainment among women of reproductive age could contribute to a reduction in preterm birth, particularly in the US South and Midwest. Further individual-level analyses engaging a diverse set of cohorts are needed to disentangle the complex interrelationships among maternal education, neighborhood-level factors, exposures across the life course, and gestational age at birth outcomes by maternal race/ethnicity and US geography.