Neighborhood-level Socioeconomic Position During Early Pregnancy and Risk of Gastroschisis

Abstract

Dayna Tulsi Neo: Neighborhood-level socioeconomic position during early pregnancy and the risk of gastroschisis (Under the direction of Andrew F. Olshan) Background: Studies have shown that pregnant women in low socioeconomic neighborhoods are at a higher risk of adverse pregnancy outcomes, including birth defects.However, few studies have explored this association with gastroschisis. Using data from the National Birth Defects Prevention Study (NBDPS), we investigated the association between neighborhood-level socioeconomic position (nSEP) during early pregnancy and the risk of gastroschisis, and evaluated whether nSEP modifies the associations between maternal age at conception and pre-pregnancy body mass index (BMI) and gastroschisis.Methods: We analyzed data from singleton case infants diagnosed with gastroschisis and singleton non-malformed control infants delivered between 1997 and 2011. To characterize nSEP, two principal component analysis (PCA)-derived indices were constructed including the Neighborhood Deprivation Index (NDI) and a Neighborhood-level Socioeconomic Position Index (nSEPI). Maternal neighborhood was defined as the self-reported address mothers lived at the longest between one month prior to conception to the third month of pregnancy. Generalized estimating equations were used to estimate odds ratios (ORs) and 95% confidence intervals (95% CIs), and relative excess risks due to interaction (RERI) were calculated to assess modification by nSEP on the additive scale.

Is gastroschisis associated with county‐level socio‐environmental quality during pregnancy?

“…In our study the association with the sociodemographic domain persisted after adjustment for individuallevel sociodemographic risk factors for gastroschisis (maternal age, education, and race/ethnicity), suggesting that while individual-level factors might partially mediate or confound the total observed effect of the sociodemographic domain estimated by the crude ORs, the county-level sociodemographic environment during early pregnancy may also have an independent role in the causal pathway(s) for gastroschisis (Robert, 1999). These findings are consistent with a recent study that investigated the association between >1200 cases of gastroschisis in the NBDPS and neighborhood-level socioeconomic position using two separate indices-the Neighborhood Deprivation Index (NDI), and the Neighborhood Socioeconomic Position Index (nSEPI) (Neo et al, 2023). In that study, women who lived in low socioeconomic-position neighborhoods during early pregnancy were more likely to deliver an infant with gastroschisis compared to women residing in high socioeconomic-position neighborhoods (OR for NDI: 2.31…”

“…The sociodemographic domain was constructed using county-level data about household income and poverty, housing quality, education, unemployment, and crime (United States Environmental Protection Agency, 2020b). Previous studies have observed associations between adverse pregnancy outcomes and these same neighborhood-level socioeconomic Census indicators (Carmichael et al, 2003;Lupo et al, 2015;Neo et al, 2023;O'Campo et al, 2008;Vinikoor-Imler et al, 2011;Wasserman et al, 1998). While our study design cannot elucidate the exact mechanisms by which such features of the social environment might contribute to the occurrence of gastroschisis, one reasonable hypothesis to be explored in future studies is whether community-level measures of socio-economic position might serve as markers for individual health behaviors (Vinikoor-Imler et al, 2011) and/or psychosocial stress, which has been previously associated with gastroschisis (Carmichael, Ma, Tinker, Shaw, & National Birth Defects Prevention Study, 2017;Ortega-García et al, 2013;Werler et al, 2018).…”

Are individual‐level risk factors for gastroschisis modified by neighborhood‐level socioeconomic factors?

“…This is the first known study to examine if nSEP modifies the associations between maternal age, pre-pregnancy BMI, and the risk of gastroschisis. Our findings build upon our previous research in this study population, which showed that high deprivation/low nSEP was associated with an increased risk of gastroschisis (Neo et al, 2023). Another strength of this study is the use of NBDPS data.…”

“…Prior studies have consistently reported associations of gastroschisis with maternal age and BMI, yet we are unaware of any other studies that have evaluated the potential influence of contextual socioeconomic factors on these unique associations. In a previous analysis of this same NBDPS population (Neo et al, 2023), we observed a monotonic increase in the odds of gastroschisis among mothers residing in moderate and high deprivation areas, after adjustment for maternal race/ethnicity, education, household income, length of residency, and birth year. Since neighborhood deprivation may differentially affect women depending on factors such as race/ethnicity, age, and others, this indicates the importance of examining how contextual factors may impact the relationships between individual-level risk factors and gastroschisis.…”

“…Two studies have previously examined whether neighborhood-level socioeconomic factors might influence risk of gastroschisis: the first study observed an increased risk among mothers residing in areas characterized by high poverty and unemployment in North Carolina (1998)(1999)(2000)(2001)(2002)(2003)(2004) (Root et al, 2011). The second study is an analysis from our research group using data from the National Birth Defects Prevention Study (NBDPS;, in which we observed an increased risk of gastroschisis associated with maternal residence during early pregnancy in areas classified as low neighborhood socioeconomic position (nSEP)/high deprivation (Neo et al, 2023).…”