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: Anne Lang Dunlop, Emory University; Mohamad Burjak, Johns Hopkins University; Lorraine T. Dean, Johns Hopkins University; Akram N. Alshawabkeh, Northeastern University; Lyndsay A. Avalos, Kaiser Permanente Northern California; Judy L. Aschner, Albert Einstein College of Medicine; Carrie V. Breton, University of Southern California; Mia A. Charifson, New York University; Jose Cordero, University of Georgia; Dana Dabelea, University of Colorado, Aurora; Viren D'Sa, Brown University; Cristiane S. Duarte, Columbia University; Amy J. Elliott, University of South Dakota, Sioux Falls; Stephanie M. Eick, Emory University; Assiamira Ferrara, Kaiser Permanente Northern California; Raina N. Fichorova, Harvard University; Jody M. Ganiban, George Washington University; James E. Gern, University of Wisconsin-Madison; Monique M. Hedderson, Kaiser Permanente Northern California; Julie B. Herbstman, Columbia University; Alison E. Hipwell, University if Pittsburgh; Kathi C. Huddleston, George Mason University; Margaret Karagas, Dartmouth College; Catherine Karr, University of Washington, Seattle; Jean M. Kerver, Michigan State University, East Lansing; Daphne Koinis-Mitchell, Brown University; Kristen Lyall, Drexel University; Juliette Madan, Dartmouth College; Carmen Marsit, Emory University; Cindy T. McEvoy, Oregon Health and Science University; John D. Meeker, University of Michigan, Ann Arbor; Emily Oken, Harvard University; T. michael O'Shea, University of North Carolina, Chapel Hill; Amy M. Padula, University of California, San Francisco; Sheela Sathyanarayana, University of Washington, Seattle; Susan Schantz, University of Illinois, Urbana-Champaign; Rebecca J. Schmidt, University of California, Davis; Jessica Snowden, University of Arkansas, Little Rock; Joseph B. Stanford, University of Utah, Salt Lake City; Scott Weiss, Harvard University; Robert O. Wright, Icahn School of Medicine at Mount Sinai; Rosalind J. Wright, Icahn School of Medicine at Mount Sinai; Xueying Zhang, Icahn School of Medicine at Mount Sinai; Monica McGrath, Johns Hopkins University
• Journal Title: Frontiers in Public Health
• Volume: Volume 11
• Publisher: Frontiers | 2023-11-30, Pages 1165089-None
• Type of Work: Article | Final Publisher PDF
• Publisher DOI: http://doi.org/10.3389/fpubh.2023.1165089
• Subjects: Health Sciences, Obstetrics and Gynecology; Health Sciences, Public Health; Sociology, Ethnic and Racial Studies
• Keywords: gestational age; premature birth; residential segregation; socioeconomic status; racial and ethnic health disparities; ECHO program

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.