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

Anne L. Dunlop; Mohamad Burjak; Lorraine T. Dean; Akram N. Alshawabkeh; Lyndsay A. Avalos; Judy L. Aschner; Carrie V. Breton; Mia A. Charifson; Jose Cordero; Dana Dabelea; Viren D’Sa; Cristiane S. Duarte; Amy J. Elliott; Stephanie M. Eick; Assiamira Ferrara; Raina N. Fichorova; Jody M. Ganiban; James E. Gern; Monique M. Hedderson; Julie B. Herbstman; Alison E. Hipwell; Kathi C. Huddleston; Margaret Karagas; Catherine Karr; Jean M. Kerver; Daphne Koinis-Mitchell; Kristen Lyall; Juliette Madan; Carmen Marsit; Cindy T. McEvoy; John D. Meeker; Emily Oken; T. Michael O’Shea; Amy M. Padula; Sheela Sathyanarayana; Susan Schantz; Rebecca J. Schmidt; Jessica Snowden; Joseph B. Stanford; Scott Weiss; Robert O. Wright; Rosalind J. Wright; Xueying Zhang; Monica McGrath

doi:10.3389/fpubh.2023.1165089

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

Anne L. Dunlop
, Mohamad Burjak
, Lorraine T. Dean
, Akram N. Alshawabkeh
, Lyndsay A. Avalos
, Judy L. Aschner
, Carrie V. Breton
, Mia A. Charifson
, Jose Cordero
, Dana Dabelea
, Viren D’Sa
, Cristiane S. Duarte
, Amy J. Elliott
, Stephanie M. Eick
, Assiamira Ferrara
, Raina N. Fichorova
, Jody M. Ganiban
, James E. Gern
, Monique M. Hedderson
, Julie B. Herbstman

Alison E. Hipwell, Kathi C. Huddleston, Margaret Karagas, Catherine Karr, Jean M. Kerver, Daphne Koinis-Mitchell, Kristen Lyall, Juliette Madan, Carmen Marsit, Cindy T. McEvoy, John D. Meeker, Emily Oken, T. Michael O’Shea, Amy M. Padula, Sheela Sathyanarayana, Susan Schantz, Rebecca J. Schmidt, Jessica Snowden, Joseph B. Stanford, Scott Weiss, Robert O. Wright, Rosalind J. Wright, Xueying Zhang, Monica McGrath

School of Medicine

Emory University
Johns Hopkins University
Northeastern University
Kaiser Permanente
University of Southern California
New York University
University of Georgia
University of Colorado Anschutz Medical Campus
Brown University
Columbia University
University of South Dakota
Harvard University
George Washington University
University of Wisconsin-Madison
University of Pittsburgh
George Mason University
Dartmouth College
University of Washington
Michigan State University
Drexel University
Oregon Health and Science University
University of Michigan, Ann Arbor
Harvard Pilgrim Health Care Institute
University of North Carolina at Chapel Hill
University of California at San Francisco
University of Illinois at Urbana-Champaign
University of California at Davis
University of Arkansas for Medical Sciences
University of Utah
Icahn School of Medicine at Mount Sinai

Research output: Contribution to journal › Article › peer-review

14 Scopus citations

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 (ICE_Race) 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 ICE_Race, 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 ICE_Race 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 ICE_Race 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 ICE_Race.

Original language	English
Article number	1165089
Journal	Frontiers in Public Health
Volume	11
DOIs	https://doi.org/10.3389/fpubh.2023.1165089
State	Published - 2023

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

SDG 3 Good Health and Well-being

Keywords

ECHO program
gestational age
premature birth
racial and ethnic health disparities
residential segregation
socioeconomic status

Access to Document

10.3389/fpubh.2023.1165089

Cite this

Dunlop, A. L., Burjak, M., Dean, L. T., Alshawabkeh, A. N., Avalos, L. A., Aschner, J. L., Breton, C. V., Charifson, M. A., Cordero, J., Dabelea, D., D’Sa, V., Duarte, C. S., Elliott, A. J., Eick, S. M., Ferrara, A., Fichorova, R. N., Ganiban, J. M., Gern, J. E., Hedderson, M. M., ... McGrath, M. (2023). 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. Frontiers in Public Health, 11, Article 1165089. https://doi.org/10.3389/fpubh.2023.1165089

@article{76b00b6286ec4d70bd3f11b28874e76e,

title = "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",

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{\textendash}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{\textquoteright}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.",

keywords = "ECHO program, gestational age, premature birth, racial and ethnic health disparities, residential segregation, socioeconomic status",

author = "Dunlop, \{Anne L.\} and Mohamad Burjak and Dean, \{Lorraine T.\} and Alshawabkeh, \{Akram N.\} and Avalos, \{Lyndsay A.\} and Aschner, \{Judy L.\} and Breton, \{Carrie V.\} and Charifson, \{Mia A.\} and Jose Cordero and Dana Dabelea and Viren D{\textquoteright}Sa and Duarte, \{Cristiane S.\} and Elliott, \{Amy J.\} and Eick, \{Stephanie M.\} and Assiamira Ferrara and Fichorova, \{Raina N.\} and Ganiban, \{Jody M.\} and Gern, \{James E.\} and Hedderson, \{Monique M.\} and Herbstman, \{Julie B.\} and Hipwell, \{Alison E.\} and Huddleston, \{Kathi C.\} and Margaret Karagas and Catherine Karr and Kerver, \{Jean M.\} and Daphne Koinis-Mitchell and Kristen Lyall and Juliette Madan and Carmen Marsit and McEvoy, \{Cindy T.\} and Meeker, \{John D.\} and Emily Oken and O{\textquoteright}Shea, \{T. Michael\} and Padula, \{Amy M.\} and Sheela Sathyanarayana and Susan Schantz and Schmidt, \{Rebecca J.\} and Jessica Snowden and Stanford, \{Joseph B.\} and Scott Weiss and Wright, \{Robert O.\} and Wright, \{Rosalind J.\} and Xueying Zhang and Monica McGrath",

note = "Publisher Copyright: Copyright {\textcopyright} 2023 Dunlop, Burjak, Dean, Alshawabkeh, Avalos, Aschner, Breton, Charifson, Cordero, Dabelea, D{\textquoteright}Sa, Duarte, Elliott, Eick, Ferrara, Fichorova, Ganiban, Gern, Hedderson, Herbstman, Hipwell, Huddleston, Karagas, Karr, Kerver, Koinis-Mitchell, Lyall, Madan, Marsit, McEvoy, Meeker, Oken, O{\textquoteright}Shea, Padula, Sathyanarayana, Schantz, Schmidt, Snowden, Stanford, Weiss, Wright, Wright, Zhang and McGrath.",

year = "2023",

doi = "10.3389/fpubh.2023.1165089",

language = "English",

volume = "11",

journal = "Frontiers in Public Health",

issn = "2296-2565",

publisher = "Frontiers Media SA",

}

Dunlop, AL, Burjak, M, Dean, LT, Alshawabkeh, AN, Avalos, LA, Aschner, JL, Breton, CV, Charifson, MA, Cordero, J, Dabelea, D, D’Sa, V, Duarte, CS, Elliott, AJ, Eick, SM, Ferrara, A, Fichorova, RN, Ganiban, JM, Gern, JE, Hedderson, MM, Herbstman, JB, Hipwell, AE, Huddleston, KC, Karagas, M, Karr, C, Kerver, JM, Koinis-Mitchell, D, Lyall, K, Madan, J, Marsit, C, McEvoy, CT, Meeker, JD, Oken, E, O’Shea, TM, Padula, AM, Sathyanarayana, S, Schantz, S, Schmidt, RJ, Snowden, J, Stanford, JB, Weiss, S, Wright, RO, Wright, RJ, Zhang, X & McGrath, M 2023, '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', Frontiers in Public Health, vol. 11, 1165089. https://doi.org/10.3389/fpubh.2023.1165089

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. / Dunlop, Anne L.; Burjak, Mohamad; Dean, Lorraine T. et al.
In: Frontiers in Public Health, Vol. 11, 1165089, 2023.

Research output: Contribution to journal › Article › peer-review

TY - JOUR

T1 - 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

AU - Dunlop, Anne L.

AU - Burjak, Mohamad

AU - Dean, Lorraine T.

AU - Alshawabkeh, Akram N.

AU - Avalos, Lyndsay A.

AU - Aschner, Judy L.

AU - Breton, Carrie V.

AU - Charifson, Mia A.

AU - Cordero, Jose

AU - Dabelea, Dana

AU - D’Sa, Viren

AU - Duarte, Cristiane S.

AU - Elliott, Amy J.

AU - Eick, Stephanie M.

AU - Ferrara, Assiamira

AU - Fichorova, Raina N.

AU - Ganiban, Jody M.

AU - Gern, James E.

AU - Hedderson, Monique M.

AU - Herbstman, Julie B.

AU - Hipwell, Alison E.

AU - Huddleston, Kathi C.

AU - Karagas, Margaret

AU - Karr, Catherine

AU - Kerver, Jean M.

AU - Koinis-Mitchell, Daphne

AU - Lyall, Kristen

AU - Madan, Juliette

AU - Marsit, Carmen

AU - McEvoy, Cindy T.

AU - Meeker, John D.

AU - Oken, Emily

AU - O’Shea, T. Michael

AU - Padula, Amy M.

AU - Sathyanarayana, Sheela

AU - Schantz, Susan

AU - Schmidt, Rebecca J.

AU - Snowden, Jessica

AU - Stanford, Joseph B.

AU - Weiss, Scott

AU - Wright, Robert O.

AU - Wright, Rosalind J.

AU - Zhang, Xueying

AU - McGrath, Monica

N1 - Publisher Copyright: Copyright © 2023 Dunlop, Burjak, Dean, Alshawabkeh, Avalos, Aschner, Breton, Charifson, Cordero, Dabelea, D’Sa, Duarte, Elliott, Eick, Ferrara, Fichorova, Ganiban, Gern, Hedderson, Herbstman, Hipwell, Huddleston, Karagas, Karr, Kerver, Koinis-Mitchell, Lyall, Madan, Marsit, McEvoy, Meeker, Oken, O’Shea, Padula, Sathyanarayana, Schantz, Schmidt, Snowden, Stanford, Weiss, Wright, Wright, Zhang and McGrath.

PY - 2023

Y1 - 2023

N2 - 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.

AB - 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.

KW - ECHO program

KW - gestational age

KW - premature birth

KW - racial and ethnic health disparities

KW - residential segregation

KW - socioeconomic status

UR - https://www.scopus.com/pages/publications/85179771121

U2 - 10.3389/fpubh.2023.1165089

DO - 10.3389/fpubh.2023.1165089

M3 - Article

C2 - 38098826

AN - SCOPUS:85179771121

SN - 2296-2565

VL - 11

JO - Frontiers in Public Health

JF - Frontiers in Public Health

M1 - 1165089

ER -

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

Abstract

UN SDGs

Keywords

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