Original ResearchObstetricsAssociations of neighborhood-level racial residential segregation with adverse pregnancy outcomes
Introduction
Compared to non-Hispanic White women, non-Hispanic Black women are more likely to experience adverse pregnancy outcomes such as preterm birth (PTB), defined as birth <37 weeks’ gestation.1, 2 This disparity in PTB is directly related to disproportionately high levels of infant mortality among Black infants.1, 2 Because differences in individual-level maternal characteristics have been unable to account fully for differences in birth outcomes, investigators have considered the environmental factors that may contribute to obstetric disparities.2, 3, 4, 5
Aspects of the social environment, particularly racial residential segregation, appear to be associated with a higher risk of experiencing adverse pregnancy outcomes.6, 7, 8, 9, 10, 11 The studies that have demonstrated these associations largely have used administrative data and have been limited to outcomes such as low birthweight (applied to newborns weighing <2500 g) or overall rates of PTB. These studies, however, have not been able to adequately assess the underlying reasons for PTB, the main subtypes being spontaneous or medically indicated etiologies. Moreover, low birthweight, which includes neonates born preterm as well as those born due to fetal growth restriction, is a grouping that ignores the differences in underlying etiologies.12 Accordingly, the relationship between segregation and small-for-gestational-age birth, which is defined as birthweight <10th percentile for their gestational age and that better reflects abnormal intrauterine growth, has not been well evaluated.12, 13, 14 Furthermore, birth certificate data often lack information regarding maternal health conditions, limiting the ability of these studies to analyze or control for individual-level variations and confounders, and this has been identified as an area needing further investigation by previous authors.11
In this study, we utilized electronic medical records, and the more granular data they provide, to examine associations of segregation among non-Hispanic Black women with overall PTB, spontaneous PTB, medically indicated PTB, and small-for-gestational-age birth.
Section snippets
Study population
Patient data from Northwestern University Memorial Hospital in Chicago, IL, were obtained from the Northwestern Medicine Enterprise Data Warehouse system. We extracted birth records for all non-Hispanic Black women who delivered singleton gestations from Jan. 1, 2009, through Dec. 31, 2013. We limited our sample to women who had a home address within the Chicago-Joliet-Naperville, IL-IN-WI metropolitan statistical area (MSA). Non-Hispanic White women were excluded from this study due to
Results
During the study period from 2009 through 2013, there were 5638 singleton births to 5114 non-Hispanic Black women at Northwestern Medicine Prentice Women’s Hospital. Of these, there were 5235 births to 4770 women with valid address information within the Chicago MSA and were thus considered for analysis. We then excluded 61 births to 51 women (1%) with missing or implausible clinical or demographic information. The final analytical sample included 5174 births to 4719 unique women who lived in
Comment
The current analysis has used electronic medical records to demonstrate the association between high levels of neighborhood-level racial segregation and the higher odds of overall PTB. Further analysis of type of PTB demonstrated a stronger relationship between spontaneous PTB than medically indicated PTB. These findings support those of prior studies,6, 7, 9 and add to those findings by differentiating between spontaneous and medically indicated PTB.
We did not find a significant association
References (39)
- et al.
Racial disparity in low birth weight and infant mortality
Clin Perinatol
(2009) - et al.
Conquering racial disparities in perinatal outcomes
Clin Perinatol
(2014) - et al.
Racial/ethnic residential segregation: framing the context of health risk and health disparities
Health Place
(2011) - et al.
Neighborhood economic disadvantage, violent crime, group density, and pregnancy outcomes in a diverse, urban population
Soc Sci Med
(2007) - et al.
Association of neighborhood context with offspring risk of preterm birth and low birthweight: a systematic review and meta-analysis of population-based studies
Soc Sci Med
(2016) - et al.
Segregation and preterm birth: the effects of neighborhood racial composition in North Carolina
Health Place
(2009) Racial disparities in low birthweight and the contribution of residential segregation: a multilevel analysis
Soc Sci Med
(2006)- et al.
Neighborhood context and reproductive health
Am J Obstet Gynecol
(2005) - et al.
Beyond individual neighborhoods: a geography of opportunity perspective for understanding racial/ethnic health disparities
Health Place
(2010) - et al.
The interaction between maternal race/ethnicity and chronic hypertension on preterm birth
Am J Obstet Gynecol
(2016)
Preterm delivery in women with pregestational diabetes mellitus or chronic hypertension relative to women with uncomplicated pregnancies. The National Institute of Child Health and Human Development Maternal-Fetal Medicine Units Network
Am J Obstet Gynecol
Preterm birth and small for gestational birthweight in relation to maternal relative hypoglycemia and chronic hypertension
Eur J Obstet Gynecol Reprod Biol
Mediating medical risk factors in the residential segregation and low birthweight relationship by race in New York City
Health Place
The intersection of neighborhood racial segregation, poverty, and urbanicity and its impact on food store availability in the United States
Prev Med
Patterns of local segregation: do they matter for neighborhood crime?
Soc Sci Res
Psychosocial stress and neuroendocrine mechanisms in preterm delivery
Am J Obstet Gynecol
Environmental exposures, toxicologic mechanisms, and adverse pregnancy outcomes
Am J Obstet Gynecol
Potential sources and racial disparities in the residential distribution of soil arsenic and lead among pregnant women
Sci Total Environ
Placental lead-induced oxidative stress and preterm delivery
Environ Toxicol Pharmacol
Cited by (0)
This study was funded internally and funding sources had no involvement in design, analysis, writing, or submission of this article.
The authors report no conflict of interest.
Cite this article as: Salow AD, Pool LR, Grobman WA, et al. Associations of neighborhood-level racial residential segregation with adverse pregnancy outcomes. Am J Obstet Gynecol 2018;218:351.e1-7.