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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

Preterm birth occurs at excessively high and disparate rates in the United States. In 2016, the National Institutes of Health (NIH) launched the Environmental influences on Child Health Outcomes (ECHO) program to investigate the influence of early life exposures on child health. Extant data from the...

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Autores principales: Dunlop, Anne L., Essalmi, Alicynne Glazier, Alvalos, Lyndsay, Breton, Carrie, Camargo, Carlos A., Cowell, Whitney J., Dabelea, Dana, Dager, Stephen R., Duarte, Cristiane, Elliott, Amy, Fichorova, Raina, Gern, James, Hedderson, Monique M., Thepaksorn, Elizabeth Hom, Huddleston, Kathi, Karagas, Margaret R., Kleinman, Ken, Leve, Leslie, Li, Ximin, Li, Yijun, Litonjua, Augusto, Ludena-Rodriguez, Yunin, Madan, Juliette C., Nino, Julio Mateus, McEvoy, Cynthia, O’Connor, Thomas G., Padula, Amy M., Paneth, Nigel, Perera, Frederica, Sathyanarayana, Sheela, Schmidt, Rebecca J., Schultz, Robert T., Snowden, Jessica, Stanford, Joseph B., Trasande, Leonardo, Volk, Heather E., Wheaton, William, Wright, Rosalind J., McGrath, Monica
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Public Library of Science 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7794036/
https://www.ncbi.nlm.nih.gov/pubmed/33418560
http://dx.doi.org/10.1371/journal.pone.0245064
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author Dunlop, Anne L.
Essalmi, Alicynne Glazier
Alvalos, Lyndsay
Breton, Carrie
Camargo, Carlos A.
Cowell, Whitney J.
Dabelea, Dana
Dager, Stephen R.
Duarte, Cristiane
Elliott, Amy
Fichorova, Raina
Gern, James
Hedderson, Monique M.
Thepaksorn, Elizabeth Hom
Huddleston, Kathi
Karagas, Margaret R.
Kleinman, Ken
Leve, Leslie
Li, Ximin
Li, Yijun
Litonjua, Augusto
Ludena-Rodriguez, Yunin
Madan, Juliette C.
Nino, Julio Mateus
McEvoy, Cynthia
O’Connor, Thomas G.
Padula, Amy M.
Paneth, Nigel
Perera, Frederica
Sathyanarayana, Sheela
Schmidt, Rebecca J.
Schultz, Robert T.
Snowden, Jessica
Stanford, Joseph B.
Trasande, Leonardo
Volk, Heather E.
Wheaton, William
Wright, Rosalind J.
McGrath, Monica
author_facet Dunlop, Anne L.
Essalmi, Alicynne Glazier
Alvalos, Lyndsay
Breton, Carrie
Camargo, Carlos A.
Cowell, Whitney J.
Dabelea, Dana
Dager, Stephen R.
Duarte, Cristiane
Elliott, Amy
Fichorova, Raina
Gern, James
Hedderson, Monique M.
Thepaksorn, Elizabeth Hom
Huddleston, Kathi
Karagas, Margaret R.
Kleinman, Ken
Leve, Leslie
Li, Ximin
Li, Yijun
Litonjua, Augusto
Ludena-Rodriguez, Yunin
Madan, Juliette C.
Nino, Julio Mateus
McEvoy, Cynthia
O’Connor, Thomas G.
Padula, Amy M.
Paneth, Nigel
Perera, Frederica
Sathyanarayana, Sheela
Schmidt, Rebecca J.
Schultz, Robert T.
Snowden, Jessica
Stanford, Joseph B.
Trasande, Leonardo
Volk, Heather E.
Wheaton, William
Wright, Rosalind J.
McGrath, Monica
author_sort Dunlop, Anne L.
collection PubMed
description Preterm birth occurs at excessively high and disparate rates in the United States. In 2016, the National Institutes of Health (NIH) launched the Environmental influences on Child Health Outcomes (ECHO) program to investigate the influence of early life exposures on child health. Extant data from the ECHO cohorts provides the opportunity to examine racial and geographic variation in effects of individual- and neighborhood-level markers of socioeconomic status (SES) on gestational age at birth. The objective of this study was to examine the association between individual-level (maternal education) and neighborhood-level markers of SES and gestational age at birth, stratifying by maternal race/ethnicity, and whether any such associations are modified by US geographic region. Twenty-six ECHO cohorts representing 25,526 mother-infant pairs contributed to this disseminated meta-analysis that investigated the effect of maternal prenatal level of education (high school diploma, GED, or less; some college, associate’s degree, vocational or technical training [reference category]; bachelor’s degree, graduate school, or professional degree) and neighborhood-level markers of SES (census tract [CT] urbanicity, percentage of black population in CT, percentage of population below the federal poverty level in CT) on gestational age at birth (categorized as preterm, early term, full term [the reference category], late, and post term) according to maternal race/ethnicity and US region. Multinomial logistic regression was used to estimate odds ratios (OR) and 95% confidence intervals (CIs). Cohort-specific results were meta-analyzed using a random effects model. For women overall, a bachelor’s degree or above, compared with some college, was associated with a significantly decreased odds of preterm birth (aOR 0.72; 95% CI: 0.61–0.86), whereas a high school education or less was associated with an increased odds of early term birth (aOR 1.10, 95% CI: 1.00–1.21). When stratifying by maternal race/ethnicity, there were no significant associations between maternal education and gestational age at birth among women of racial/ethnic groups other than non-Hispanic white. Among non-Hispanic white women, a bachelor’s degree or above was likewise associated with a significantly decreased odds of preterm birth (aOR 0.74 (95% CI: 0.58, 0.94) as well as a decreased odds of early term birth (aOR 0.84 (95% CI: 0.74, 0.95). The association between maternal education and gestational age at birth varied according to US region, with higher levels of maternal education associated with a significantly decreased odds of preterm birth in the Midwest and South but not in the Northeast and West. Non-Hispanic white women residing in rural compared to urban CTs had an increased odds of preterm birth; the ability to detect associations between neighborhood-level measures of SES and gestational age for other race/ethnic groups was limited due to small sample sizes within select strata. Interventions that promote higher educational attainment among women of reproductive age could contribute to a reduction in preterm birth, particularly in the US South and Midwest. Further individual-level analyses engaging a diverse set of cohorts are needed to disentangle the complex interrelationships among maternal education, neighborhood-level factors, exposures across the life course, and gestational age at birth outcomes by maternal race/ethnicity and US geography.
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spelling pubmed-77940362021-01-21 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 Dunlop, Anne L. Essalmi, Alicynne Glazier Alvalos, Lyndsay Breton, Carrie Camargo, Carlos A. Cowell, Whitney J. Dabelea, Dana Dager, Stephen R. Duarte, Cristiane Elliott, Amy Fichorova, Raina Gern, James Hedderson, Monique M. Thepaksorn, Elizabeth Hom Huddleston, Kathi Karagas, Margaret R. Kleinman, Ken Leve, Leslie Li, Ximin Li, Yijun Litonjua, Augusto Ludena-Rodriguez, Yunin Madan, Juliette C. Nino, Julio Mateus McEvoy, Cynthia O’Connor, Thomas G. Padula, Amy M. Paneth, Nigel Perera, Frederica Sathyanarayana, Sheela Schmidt, Rebecca J. Schultz, Robert T. Snowden, Jessica Stanford, Joseph B. Trasande, Leonardo Volk, Heather E. Wheaton, William Wright, Rosalind J. McGrath, Monica PLoS One Research Article Preterm birth occurs at excessively high and disparate rates in the United States. In 2016, the National Institutes of Health (NIH) launched the Environmental influences on Child Health Outcomes (ECHO) program to investigate the influence of early life exposures on child health. Extant data from the ECHO cohorts provides the opportunity to examine racial and geographic variation in effects of individual- and neighborhood-level markers of socioeconomic status (SES) on gestational age at birth. The objective of this study was to examine the association between individual-level (maternal education) and neighborhood-level markers of SES and gestational age at birth, stratifying by maternal race/ethnicity, and whether any such associations are modified by US geographic region. Twenty-six ECHO cohorts representing 25,526 mother-infant pairs contributed to this disseminated meta-analysis that investigated the effect of maternal prenatal level of education (high school diploma, GED, or less; some college, associate’s degree, vocational or technical training [reference category]; bachelor’s degree, graduate school, or professional degree) and neighborhood-level markers of SES (census tract [CT] urbanicity, percentage of black population in CT, percentage of population below the federal poverty level in CT) on gestational age at birth (categorized as preterm, early term, full term [the reference category], late, and post term) according to maternal race/ethnicity and US region. Multinomial logistic regression was used to estimate odds ratios (OR) and 95% confidence intervals (CIs). Cohort-specific results were meta-analyzed using a random effects model. For women overall, a bachelor’s degree or above, compared with some college, was associated with a significantly decreased odds of preterm birth (aOR 0.72; 95% CI: 0.61–0.86), whereas a high school education or less was associated with an increased odds of early term birth (aOR 1.10, 95% CI: 1.00–1.21). When stratifying by maternal race/ethnicity, there were no significant associations between maternal education and gestational age at birth among women of racial/ethnic groups other than non-Hispanic white. Among non-Hispanic white women, a bachelor’s degree or above was likewise associated with a significantly decreased odds of preterm birth (aOR 0.74 (95% CI: 0.58, 0.94) as well as a decreased odds of early term birth (aOR 0.84 (95% CI: 0.74, 0.95). The association between maternal education and gestational age at birth varied according to US region, with higher levels of maternal education associated with a significantly decreased odds of preterm birth in the Midwest and South but not in the Northeast and West. Non-Hispanic white women residing in rural compared to urban CTs had an increased odds of preterm birth; the ability to detect associations between neighborhood-level measures of SES and gestational age for other race/ethnic groups was limited due to small sample sizes within select strata. Interventions that promote higher educational attainment among women of reproductive age could contribute to a reduction in preterm birth, particularly in the US South and Midwest. Further individual-level analyses engaging a diverse set of cohorts are needed to disentangle the complex interrelationships among maternal education, neighborhood-level factors, exposures across the life course, and gestational age at birth outcomes by maternal race/ethnicity and US geography. Public Library of Science 2021-01-08 /pmc/articles/PMC7794036/ /pubmed/33418560 http://dx.doi.org/10.1371/journal.pone.0245064 Text en © 2021 Dunlop et al http://creativecommons.org/licenses/by/4.0/ This is an open access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0/) , which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
spellingShingle Research Article
Dunlop, Anne L.
Essalmi, Alicynne Glazier
Alvalos, Lyndsay
Breton, Carrie
Camargo, Carlos A.
Cowell, Whitney J.
Dabelea, Dana
Dager, Stephen R.
Duarte, Cristiane
Elliott, Amy
Fichorova, Raina
Gern, James
Hedderson, Monique M.
Thepaksorn, Elizabeth Hom
Huddleston, Kathi
Karagas, Margaret R.
Kleinman, Ken
Leve, Leslie
Li, Ximin
Li, Yijun
Litonjua, Augusto
Ludena-Rodriguez, Yunin
Madan, Juliette C.
Nino, Julio Mateus
McEvoy, Cynthia
O’Connor, Thomas G.
Padula, Amy M.
Paneth, Nigel
Perera, Frederica
Sathyanarayana, Sheela
Schmidt, Rebecca J.
Schultz, Robert T.
Snowden, Jessica
Stanford, Joseph B.
Trasande, Leonardo
Volk, Heather E.
Wheaton, William
Wright, Rosalind J.
McGrath, Monica
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
title 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
title_full 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
title_fullStr 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
title_full_unstemmed 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
title_short 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
title_sort 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
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7794036/
https://www.ncbi.nlm.nih.gov/pubmed/33418560
http://dx.doi.org/10.1371/journal.pone.0245064
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