Association of neighborhood context with offspring risk of preterm birth and low birthweight: A systematic review and meta-analysis of population-based studies

Abstract

Findings from studies investigating associations of residential environment with poor birth outcomes have been inconsistent. In a systematic review and meta-analysis, we examined associations of neighborhood disadvantage with preterm birth (PTB) and low birthweight (LBW), and explored differences in relationships among racial groups. Two reviewers searched English language articles in electronic databases of published literature. We used random effects logistic regression to calculate odds ratios (and 95% confidence intervals) relating neighborhood disadvantage with PTB and LBW. Neighborhood disadvantage, most disadvantaged versus least disadvantaged neighborhoods, was defined by researchers of included studies, and comprised of poverty, deprivation, racial residential segregation or racial composition, and crime. We identified 1314 citations in the systematic review. The meta-analyses included 7 PTB and 14 LBW cross-sectional studies conducted in the United States (U.S.). Overall, we found 27% [95%CI: 1.16, 1.39] and 11% [95%CI: 1.07, 1.14] higher risk for PTB and LBW among the most disadvantaged compared with least disadvantaged neighborhoods. No statistically significant association was found in meta-analyses of studies that adjusted for race. In race-stratified meta-analyses models, we found 48% [95%CI: 1.25, 1.75] and 61% [95%CI: 1.30, 2.00] higher odds of PTB and LBW among non-Hispanic white mothers living in most disadvantaged neighborhoods compared with those living in least disadvantaged neighborhoods. Similar, but less strong, associations were observed for PTB (15% [95%CI: 1.09, 1.21]) and LBW (17% [95%CI: 1.10, 1.25]) among non-Hispanic black mothers. Neighborhood disadvantage is associated with PTB and LBW, however, associations may differ by race. Future studies evaluating causal mechanisms underlying the associations, and racial/ethnic differences in associations, are warranted.

Neighborhood disadvantage and preterm delivery in Urban African Americans: The moderating role of religious coping

“…7-17 Results from a recent meta-analysis, which included three studies focused on AAs, all of which used vital statistics data, suggested modest positive associations, with a stronger relationship among Whites compared to AAs. 17 However, limitations of using vital statistics data include inaccurate reporting of clinical information including gestational age, and that the data is collected for public health surveillance, rather than to answer specific clinical or population-based research questions. 18 …”

Living in violence: Neighborhood domestic violence and small for gestational age births

“…This finding is consistent with several other studies on adverse birth outcomes and neighborhood-level risk factors, such that neighborhood effects among Black women are greater and more variable than among White women. 13 A possible explanation for the small within racial group difference could be due to unmeasured confounding among Whites, such that observable differences in high domestic violence and low domestic violence neighborhoods on SGA births were minimized 7,11 . Nonetheless, findings on neighborhood-level risk factors and adverse birth outcomes remain inconsistent.…”

“…3–5 Efforts to understand why risk differences persist are increasingly focused on broader, contextual factors beyond individual characteristics, with the understanding that the environment in which people live, work, and grow can influence health. 6–11 Previous explorations of neighborhood-level determinants of adverse birth outcomes have predominantly focused on socioeconomic indicators such as poverty and unemployment rates, median household income, and the concentration of economic disadvantage that occurs in racially segregated areas. 9,12 While area-level socioeconomic disparities have been consistently associated with adverse birth outcomes, socioeconomic conditions alone fail to capture the multiple ways in which neighborhood context influences racial disparities in women’s health, 10,13 and there is a need to better understand the mechanisms through which neighborhood conditions may impact birth outcomes.…”

“…22 Two other studies found that living in less deprived or higher income neighborhoods increased the risk of preterm birth for Black women but not for White women; 13,23 yet, another study found that living in areas of high concentrated disadvantage were associated with adverse birth outcomes for White women, but not for Black women. 9,11 Reasons underlying the differential impact by race remain unclear but may be related to larger structural forces, including structural racism, exposure over the life-course, or even more proximal neighborhood conditions as well as differences in coping with stress. 24 …”

Getting Under the Skin: Children’s Health Disparities as Embodiment of Social Class

“…Leventhal & Brooks-Gunn, 2004). Much work reports that women living in disadvantaged neighborhoods are more likely to deliver infants preterm or low birth weights (Culhane & Elo, 2005; Margerison-Zilko et al, 2015; Masi, Hawkley, Piotrowski, & Pickett, 2007; Morenoff, 2003; Ncube, Enquobahrie, Albert, Herrick, & Burke, 2016; O’Campo et al, 2008; Vos, Posthumus, Bonsel, Steegers, & Denktas, 2014), suggesting possible intergenerational effects of neighborhood context, whereby the influence of disadvantaged environments on child health begins in utero or prior to conception. A small body of research has examined the specific pathways by which early-life neighborhood exposures influence children’s health.…”