摘要：Objectives. We sought to determine whether the effects of preconception stressful life events (PSLEs) on birth weight differed by neighborhood disadvantage. Methods. We drew our data from the Early Childhood Longitudinal Study, Birth Cohort (2001–2002; n = 9300). We created a neighborhood disadvantage index (NDI) using county-level data from the 2000 US Census. We grouped the NDI into tertiles that represented advantaged, middle advantaged, and disadvantaged neighborhoods. Stratified multinomial logistic regressions estimated the effect of PSLEs on birth weight, controlling for confounders. Results. We found a gradient in the relationship between women’s exposure to PSLEs and having a very low birth weight (VLBW) infant by NDI tertile; the association was strongest in disadvantaged neighborhoods (adjusted odd ratio [AOR] = 1.62; 95% confidence interval [CI] = 1.04, 2.53), followed by middle (AOR = 1.39; 95% CI = 1.00, 1.93) and advantaged (AOR = 1.29; 95% CI = 0.91, 1.82) neighborhoods. We observed a similar gradient for women with chronic conditions and among minority mothers. Conclusions. Women who experienced PSLEs, who had chronic conditions, or were racial/ethnic minorities had the greatest risk of having VLBW infants if they lived in disadvantaged neighborhoods; this suggests exacerbation of risk within disadvantaged environments. Interventions to reduce rates of VLBW should focus on reducing the deleterious effects of stressors and on improving neighborhood conditions. A growing body of literature emphasizes the importance of examining risk factors not only during pregnancy, but also from early life and across a woman’s life span when investigating obstetric outcomes. 1 Studies have demonstrated that exposure to preconception stressful life events (PSLEs) increases the risk for adverse birth outcomes, including giving birth to very low birth weight (VLBW) 2 or preterm infants. 3,4 Maternal chronic conditions have also been significantly associated with an increased risk of low birth weight (LBW) and preterm birth. 5 It is well documented that non-Hispanic Black women are more likely to have LBW 6 or VLBW 7 infants compared with their non-Hispanic White counterparts. Local contexts, including neighborhoods, may influence health outcomes above and beyond individual-level characteristics. 8 Disadvantaged neighborhood conditions, characterized by lower neighborhood socioeconomic status, lower neighborhood social relations and engagement, higher rates of violent crime, or higher levels of perceived social and physical disorder and discrimination, may adversely affect birth weight, 8 preterm birth, 9,10 or both, 10–13 independent of individual risk factors. Furthermore, neighborhood conditions have also been shown to modify the effect of maternal psychosocial stress on physical health 14 and the risk of having a LBW infant or preterm birth. 15 Adverse neighborhood conditions may also exacerbate racial disparities in women’s health or birth outcomes. For example, compared with non-Hispanic White women, non-Hispanic Black women are more likely to experience adverse health conditions and have higher risks of having a LBW infant or preterm birth as a result of perpetual social and environmental insults or prolonged active coping with stressful circumstances that are linked with living in disadvantaged neighborhoods. 15–17 However, to the best of our knowledge, no study has investigated the impact of neighborhood conditions on the association between stressful life events prior to pregnancy and birth weight in a national sample of women living in the United States. To address this gap in the literature, we used population-based data available from the Early Childhood Longitudinal Study, Birth Cohort (ECLS-B) to determine whether the deleterious effects of preconception factors, such as PSLEs, maternal chronic disease, or race/ethnicity, on birth weight were exacerbated by living in a disadvantaged neighborhood. An analytical model was presented to clarify this research question ( Figure 1 ). Findings from our study provide critical information about how neighborhood conditions influence the association between maternal experiences before or during pregnancy and birth weight. Open in a separate window FIGURE 1— Analytical model of neighborhood disadvantage, preconception stressful life events, and infant birth weight.
