Early-life neighborhood context, perceived stress, and preterm birth in African American Women

Abstract

Stressors from multiple sources, across the life-course, may have independent and joint associations with preterm birth (PTB) risk in African American women. Using data from the Life-course Influences on Fetal Environments Study (LIFE; 2009–2011) of post-partum African American women from Metropolitan Detroit, Michigan (n=1365), we examined the association between perceived stress and PTB, and effect modification by perceptions of early-life neighborhood social control and disorder. We defined PTB as birth before 37 completed weeks of gestation. We used Cohen’s Perceived Stress scale, and valid and reliable scales of early-life (age 10) neighborhood social control and social disorder to quantify exposures. We estimated prevalence ratios (PR) and 95% confidence intervals (CI) with log binomial regression models- with separate interaction terms for perceived stress and each early-life neighborhood scale. We considered p < 0.10 significant for interaction terms. PTB occurred in 16.4% (n=224) of the study participants. In the total sample, perceived stress was not associated with PTB rates. However, there was suggestive evidence of a joint association between perceived stress and early-life neighborhood social disorder (p for interaction = 0.06), such that among women who reported high early-life neighborhood social disorder (n=660), perceived stress was positively associated with PTB (adjusted PR: 1.31; 95% CI: 1.05, 1.63). There was no association between perceived stress and PTB for women in the low early-life neighborhood social disorder strata (n=651) (adjusted PR: 0.95, 95% CI: 0.75, 1.21). There was no evidence that early-life neighborhood social control modified the association between perceived stress and PTB. Our results suggest that early-life neighborhood stressors may magnify the association between current perceived stress and PTB rates, in African American women. More research to confirm and explicate the biologic and/or psychosocial mechanisms of the reported association is warranted.

Neighborhood-Level Mass Incarceration and Future Preterm Birth Risk among African American Women

“…We heed recent calls to abandon reliance on statistical significance in interpreting research results, in favor of more detailed and nuanced presentation and of statistical analyses, with the recognition that p values and decisions about what research ideas should be explored further have no association [23]. Given the literature on neighborhood effects on PTB among African American women which identified few true confounders [19,24], and the literature on the community effects of mass incarceration [14], sociodemographic variables may lie on the pathway linking preconception neighborhood mass incarceration to PTB. Adjusting for potential mediators would compromise the precision of our estimates, and attenuate the associations we were trying to identify [25]; we therefore present unadjusted models.…”

Preterm birth and nativity among Black women with gestational diabetes in California, 2013–2017: a population-based retrospective cohort study

“…Our study findings also demonstrate that after a history of a prior PTB, preeclampsia was the overall greatest predictor of early PTB, late PTB, and early term birth among Black women with GDM. The large effect of preeclampsia risk for all gestational groups, given no evidence of interaction between nativity and preeclampsia, suggests a potential role for unmeasured independent variables, such as stress, inflammation, or chronic hypertension as potential pathways for PTB [ 34 , 52 ]. GDM and preeclampsia may also act synergistically through a common pathway of inflammation, where PTB may also be an indicator of vascular dysfunction [ 53 ], given the significant associations between, preeclampsia, smoking and PTB.…”

“…A group of Black and Brown women scholars in obstetrics gynecology, maternal fetal medicine, family planning, and public health recently asserted that “despite evidence describing the relationship between structural racism, health outcomes and healthcare care experiences in the literature by transdisciplinary experts in the social sciences, humanities, legal studies, public health, and health services research, knowledge construction by obstetricians, perinatologists, and gynecologists about the impact of structural racism on PRH inequity is lacking” [ 29 ]. Quantitative public health research on PRH, specifically PTB, by Black women scholars provide substantial evidence, with both scientific and cultural rigor, on the utility of correlating adverse PRH outcomes among Black birthing communities with traditional and novel measures of structural racism, such as neighborhood level segregation and census tract data [ 34 – 37 ], and county-level disparities in incarceration and elected officials [ 38 ]; 3) Conceptualization and Measurement: The exclusion of white women as a control group for all three gestational groups (early PTB, late PTB, and early term) allows for better examination of within group variations among Black women birthing in California hospitals based on nativity [ 8 , 39 ] and other clinical factors without reinforcing race as a biological construct or advantage in examining the racialized phenomenon of pregnancy, GDM, and PTB among Black women [ 40 ]. Likewise, utilization of interaction analysis and backward stepwise regression modeling allows for the operationalization of intersectionality in quantitative population health research [ 18 , 41 – 43 ].…”

Research priorities of women at risk for preterm birth: findings and a call to action

“…However, population level reduction in preterm birth rates have not been achieved with widespread implementation of these interventions and there has been growing realization that clinical interventions focused on individuals alone are ineffective in addressing the ongoing preterm birth epidemic [26,27]. Moreover, the US preterm birth rate far exceeds that of other high income countries, and within the US, there are significant health disparities among demographic groups that are not adequately explained by the known clinical causes or access to available treatments, with women of color experiencing higher rates than white women and the highest rates occurring for non-Hispanic Black women [28,29]. Our thorough search of the literature did not show any prior example of research priority setting with women from communities with high risk for preterm birth.…”