Contribution of maternal cardiometabolic risk factors to racial-ethnicity disparities in preterm birth subtypes

Hedderson, Monique M.; Xu, Fei; Dayo, Olumayowa; Liu, Emily F.; Sridhar, Sneha B.; Lee, Catherine; Greenberg, Mara

doi:10.1016/j.ajogmf.2022.100608

Cited by 8 publications

(4 citation statements)

References 34 publications

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“…We selected primary confounders a priori from the literature, including self-reported maternal race and ethnicity (categorical), education (categorical), maternal age at enrollment (years), and prepregnancy body mass index . Race and ethnicity was used as a confounder based on the consistent disparities in preterm birth and environmental exposures experienced by minoritized racial and ethnic populations in the US, which is driven by social determinants including racism and discrimination . We defined race and ethnicity by combining several self-identified categories to maximize sample size and consistency across pooled studies, including non-Hispanic Black, Hispanic/Latina, non-Hispanic White, and other (including American Indian/Alaskan Native, Native Hawaiian, >1 racial identity, or reported as other).…”

Section: Methodsmentioning

confidence: 99%

Associations Between Prenatal Urinary Biomarkers of Phthalate Exposure and Preterm Birth

et al. 2022

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and the Pooled Phthalate Exposure and Preterm Birth Study Group IMPORTANCE Phthalate exposure is widespread among pregnant women and may be a risk factor for preterm birth.OBJECTIVE To investigate the prospective association between urinary biomarkers of phthalates in pregnancy and preterm birth among individuals living in the US. DESIGN, SETTING, AND PARTICIPANTSIndividual-level data were pooled from 16 preconception and pregnancy studies conducted in the US. Pregnant individuals who delivered between 1983 and 2018 and provided 1 or more urine samples during pregnancy were included.EXPOSURES Urinary phthalate metabolites were quantified as biomarkers of phthalate exposure. Concentrations of 11 phthalate metabolites were standardized for urine dilution and mean repeated measurements across pregnancy were calculated. MAIN OUTCOMES AND MEASURESLogistic regression models were used to examine the association between each phthalate metabolite with the odds of preterm birth, defined as less than 37 weeks of gestation at delivery (n = 539). Models pooled data using fixed effects and adjusted for maternal age, race and ethnicity, education, and prepregnancy body mass index. The association between the overall mixture of phthalate metabolites and preterm birth was also examined with logistic regression. G-computation, which requires certain assumptions to be considered causal, was used to estimate the association with hypothetical interventions to reduce the mixture concentrations on preterm birth. RESULTSThe final analytic sample included 6045 participants (mean [SD] age, 29.1 [6.1] years). Overall, 802 individuals (13.3%) were Black, 2323 (38.4%) were Hispanic/Latina, 2576 (42.6%) were White, and 328 (5.4%) had other race and ethnicity (including American Indian/Alaskan Native, Native Hawaiian, >1 racial identity, or reported as other). Most phthalate metabolites were detected in more than 96% of participants. Higher odds of preterm birth, ranging from 12% to 16%, were observed in association with an interquartile range increase in urinary concentrations of mono-N-butyl phthalate (odds ratio [OR], 1.12 [95% CI, 0.98-1.27]), mono-isobutyl phthalate (OR, 1.16 [95% CI, 1.00-1.34]), mono(2-ethyl-5-carboxypentyl) phthalate (OR, 1.16 [95% CI, 1.00-1.34]), and mono(3-carboxypropyl) phthalate (OR, 1.14 [95% CI, 1.01-1.29]). Among approximately 90 preterm births per 1000 live births in this study population, hypothetical interventions to reduce the mixture of phthalate metabolite levels by 10%, 30%, and 50% were estimated to prevent 1.8 (95% CI, 0.5-3.1), 5.9 (95% CI, 1.7-9.9), and 11.1 (95% CI, 3.6-18.3) preterm births, respectively. CONCLUSIONS AND RELEVANCEResults from this large US study population suggest that phthalate exposure during pregnancy may be a preventable risk factor for preterm delivery.

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Section: Methodsmentioning

confidence: 99%

Associations Between Prenatal Urinary Biomarkers of Phthalate Exposure and Preterm Birth

et al. 2022

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“…Given this is the first study that evaluated the potential mediation role of PBDEs for this disparity, future studies of larger sample sizes or conducted among a higher-risk population might be needed to validate our findings. Past studies have revealed other mediators (such as socioeconomic and health factors, and access to healthcare) for the racial and ethnic disparity in PTB, but a large proportion of the disparity remained ( 9 – 11 , 71 – 73 ). If PBDEs truly mediate part of the racial and ethnic disparity in length of gestation or PTB, then this class of chemicals might be an additional modifiable factor to help further alleviate this disparity.…”

Section: Discussionmentioning

confidence: 99%

Racial and ethnic disparities in preterm birth: a mediation analysis incorporating mixtures of polybrominated diphenyl ethers

Wang,

Zhang,

Williams

et al. 2024

Front. Reprod. Health

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BackgroundRacial and ethnic disparities persist in preterm birth (PTB) and gestational age (GA) at delivery in the United States. It remains unclear whether exposure to environmental chemicals contributes to these disparities.ObjectivesWe applied recent methodologies incorporating environmental mixtures as mediators in causal mediation analysis to examine whether racial and ethnic disparities in GA at delivery and PTB may be partially explained by exposures to polybrominated diphenyl ethers (PBDEs), a class of chemicals used as flame retardants in the United States.MethodsData from a multiracial/ethnic US cohort of 2008 individuals with low-risk singleton pregnancies were utilized, with plasma PBDE concentrations measured during early pregnancy. We performed mediation analyses incorporating three forms of mediators: (1) reducing all PBDEs to a weighted index, (2) selecting a PBDE congener, or (3) including all congeners simultaneously as multiple mediators, to evaluate whether PBDEs may contribute to the racial and ethnic disparities in PTB and GA at delivery, adjusted for potential confounders.ResultsAmong the 2008 participants, 552 self-identified as non-Hispanic White, 504 self-identified as non-Hispanic Black, 568 self-identified as Hispanic, and 384 self-identified as Asian/Pacific Islander. The non-Hispanic Black individuals had the highest mean ∑PBDEs, the shortest mean GA at delivery, and the highest rate of PTB. Overall, the difference in GA at delivery comparing non-Hispanic Black to non-Hispanic White women was −0.30 (95% CI: −0.54, −0.05) weeks. This disparity reduced to −0.23 (95% CI: −0.49, 0.02) and −0.18 (95% CI: −0.46, 0.10) weeks if fixing everyone's weighted index of PBDEs to the median and the 25th percentile levels, respectively. The proportion of disparity mediated by the weighted index of PBDEs was 11.8%. No statistically significant mediation was found for PTB, other forms of mediator(s), or other racial and ethnic groups.ConclusionPBDE mixtures may partially mediate the Black vs. White disparity in GA at delivery. While further validations are needed, lowering the PBDEs at the population level might help reduce this disparity.

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“…We further classified PTB into spontaneous and medically indicated based on a previously validated algorithm. 17 Gestational hypertension was identified by ICD-9 codes 642.3 and 642.9 and ICD-10 codes O13 and O16; preeclampsia or eclampsia was identified by ICD-9 codes 642.4, 642.5, 642.6, and 642.7 and ICD-10 codes O11, O14, and O15.…”

Section: Methodsmentioning

confidence: 99%

Perinatal Outcomes After Bariatric Surgery Compared With a Matched Control Group

Boller

Lee

et al. 2023

Obstetrics &Amp; Gynecology

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Contribution of maternal cardiometabolic risk factors to racial-ethnicity disparities in preterm birth subtypes

Cited by 8 publications

References 34 publications

Associations Between Prenatal Urinary Biomarkers of Phthalate Exposure and Preterm Birth

Associations Between Prenatal Urinary Biomarkers of Phthalate Exposure and Preterm Birth

Racial and ethnic disparities in preterm birth: a mediation analysis incorporating mixtures of polybrominated diphenyl ethers

Perinatal Outcomes After Bariatric Surgery Compared With a Matched Control Group

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