Racial and geographic variation in effects of maternal education and neighborhood-level measures of socioeconomic status on gestational age at birth: Findings from the ECHO cohorts

• DOI: 10.1371/journal.pone.0245064
• Publication Date: 2021-01-09T04:52:12Z
• Authors: Anne L. Dunlop; Alicynne Glazier ...; Lyndsay Alvalos; Carrie Breton; Carlos A. Camargo; Whitney J. Cowell; Dana Dabelea; Stephen R. Dager; Cristiane Duarte; Amy Elliott; Raina Fichorova; James Gern; Monique M. Hedderson; Elizabeth Hom The...; Kathi Huddleston; Margaret R. Karagas; Ken Kleinman; Leslie Leve; Ximin Li; Yijun Li; Augusto Litonjua; Yunin Ludena-Rodr...; Juliette C. Madan; Julio Mateus Nino; Cynthia McEvoy; Thomas G. O’Connor; Amy M. Padula; Nigel Paneth; Frederica Perera; Sheela Sathyanara...; Rebecca J. Schmidt; Robert T. Schultz; Jessica Snowden; Joseph B. Stanford; Leonardo Trasande; Heather E. Volk; William Wheaton; Rosalind J. Wright; Monica McGrath
• Keywords: STRESS; Epidemiology; Social Determinants of Health; Maternal Health; Reproductive health and childbirth; Low Birth Weight and Health of the Newborn; CHILD HEALTH OUTCOMES; Pregnancy; Ethnicity; Minority Health; 10. No inequality; program collaborators for Environmental Influences on Child Health Outcomes; RISK; Pediatric; 4. Education; Q; R; 1. No poverty; 3. Good health; Health Disparities; Medicine; Female; Public Health; Research Article; Maternal Age; Adult; PRETERM BIRTH; ETHNIC DISPARITIES; General Science & Technology; Science; 610; Mothers; Gestational Age; ENVIRONMENTAL-INFLUENCES; 618; MULTIPLE IMPUTATION; Clinical Research; Preterm; Health Sciences; Behavioral and Social Science; Humans; Other Medicine and Health Sciences; US; Prevention; Infant, Newborn; Infant; AIR-POLLUTION; Perinatal Period - Conditions Originating in Perinatal Period; Newborn; United States; Quality Education; CONTEXT; Social Class; Women's Health

Preterm birth occurs at excessively high and disparate rates in the United States. In 2016, National Institutes of Health (NIH) launched Environmental influences on Child Outcomes (ECHO) program to investigate influence early life exposures child health. Extant data from ECHO cohorts provides opportunity examine racial geographic variation effects individual- neighborhood-level markers socioeconomic status (SES) gestational age birth. The objective this study was association between individual-level (maternal education) SES birth, stratifying by maternal race/ethnicity, whether any such associations are modified US region. Twenty-six representing 25,526 mother-infant pairs contributed disseminated meta-analysis that investigated effect prenatal level education (high school diploma, GED, or less; some college, associate’s degree, vocational technical training [reference category]; bachelor’s graduate school, professional degree) (census tract [CT] urbanicity, percentage black population CT, below federal poverty CT) (categorized as preterm, term, full term [the reference category], late, post term) according race/ethnicity Multinomial logistic regression used estimate odds ratios (OR) 95% confidence intervals (CIs). Cohort-specific results were meta-analyzed using a random model. For women overall, degree above, compared with associated significantly decreased preterm (aOR 0.72; CI: 0.61–0.86), whereas less an increased 1.10, 1.00–1.21). When there no significant among racial/ethnic groups other than non-Hispanic white. Among white women, above likewise 0.74 (95% 0.58, 0.94) well 0.84 0.74, 0.95). varied region, higher levels Midwest South but not Northeast West. Non-Hispanic residing rural urban CTs had birth; ability detect measures for race/ethnic limited due small sample sizes within select strata. Interventions promote educational attainment reproductive could contribute reduction particularly Midwest. Further analyses engaging diverse set needed disentangle complex interrelationships education, factors, across course, outcomes geography.