Economic Conditions During Pregnancy and Adverse Birth Outcomes Among Singleton Live Births in the United States, 1990-2013.

We know little about the relationship between the macroeconomy and birth outcomes, in part due to the methodological challenge of distinguishing effects of economic conditions on fetal health from effects of economic conditions on selection into live birth. We examined associations between state-level unemployment rates in the first 2 trimesters of pregnancy and adverse birth outcomes, using natality data on singleton live births in the United States during 1990-2013. We used fixed-effect logistic regression models and accounted for selection by adjusting for state-level unemployment before conception and maternal characteristics associated with both selection and birth outcomes. We also tested whether associations between macroeconomic conditions and birth outcomes differed during and after (compared with before) the Great Recession (2007-2009). Each 1-percentage-point increase in the first-trimester unemployment rate was associated with a 5% increase in odds of preterm birth, while second-trimester unemployment was associated with a 3% decrease in preterm birth odds. During the Great Recession, however, first-trimester unemployment was associated with a 16% increase in odds of preterm birth. These findings increase our understanding of the effects of the Great Recession on health and add to growing literature suggesting that macro-level social and economic factors contribute to perinatal health.

Stressors Across the Life-Course and Preterm Delivery: Evidence From a Pregnancy Cohort.

Objectives Growing evidence suggests that pre-conception stressors are associated with increased risk of preterm delivery (PTD). Our study assesses stressors in multiple domains at multiple points in the life course (i.e., childhood, adulthood, within 6 months of pregnancy) and their relation to PTD. We also examine heterogeneity of associations by race/ethnicity, PTD timing, and PTD clinical circumstance. Methods We assessed stressors retrospectively via mid-pregnancy questionnaires in the Pregnancy Outcomes and Community Health Study (1998-2004), a Michigan pregnancy cohort (n = 2559). Stressor domains included abuse/witnessing violence (hereafter "abuse"), loss, economic stress, and substance use. We used logistic and multinomial regression for the following outcomes: PTD (<37 weeks' gestation), PTD by timing (≤34 weeks, 35-36 weeks) and PTD by clinical circumstance (medically indicated, spontaneous). Covariates included race/ethnicity, education, parity, and marital status. Results Stressors in the previous 6 months were not associated with PTD. Experiencing abuse during both childhood and adulthood increased adjusted odds of PTD among women of white or other race/ethnicity only (aOR 1.6, 95 % CI 1.1, 2.5). Among all women, abuse in childhood increased odds of late PTD (aOR 1.5, 95 % CI 1.0, 2.2) while abuse in both childhood and adulthood non-significantly increased odds of early PTD (aOR 1.6, 95 % CI 0.9, 2.7). Sexual, but not physical, abuse in both childhood and adulthood increased odds of PTD (aOR 1.9, 95 % CI 1.0, 3.5). Conclusions Experiences of abuse-particularly sexual abuse-across the life-course may be important considerations when assessing PTD risk. Our results motivate future studies of pathways linking abuse and PTD.

Trimester of maternal gestational weight gain and offspring body weight at birth and age five.

To investigate associations of trimester-specific GWG with fetal birth size and BMI at age 5 years. We examined 3,015 singleton births to women without pregnancy complications from the Child Health and Development Studies prospective cohort with measured weights during pregnancy. We used multivariable regression to examine the associations between total and trimester gestational weight gain (GWG) and birth weight for gestational age and child BMI outcomes, adjusting for maternal age, race/ethnicity, education, marital status, parity, pre-pregnancy body mass index (BMI), and smoking; paternal overweight, gestational age, and infant sex. We explored differences in associations by maternal BMI and infant sex. GWG in all trimesters was significantly and independently associated with birth weight with associations stronger, though not significantly, in the second trimester. First trimester GWG was associated with child BMI outcomes (OR for child overweight = 1.05; 95% CI = 1.02, 1.09). Each kg of first trimester GWG was significantly associated with increased child BMI z-score in women of low (ß = 0.099; 95% CI = 0.034, 0.163) and normal (ß = 0.028; 95% CI = 0.012, 0.044), but not high pre-pregnancy BMI. GWG in all trimesters was associated with birth weight; only first trimester GWG was associated with child BMI. If replicated, this information could help specify recommendations for maternal GWG and elucidate mechanisms connecting GWG to child BMI.

Maternal exposure to unexpected economic contraction and birth weight for gestational age.

BACKGROUND: The macro-level economy may affect fetal health through maternal behavioral or physiologic responses. METHODS: We used a multilevel design to examine associations between exposure to state-level unexpected economic contraction during each trimester of gestation and birth weight for gestational age percentile and small for gestational age (SGA), using the National Longitudinal Survey of Youth 1979. We examined differences in observed associations by maternal educational attainment, race/ethnicity, employment status, and poverty status. RESULTS: Exposure in the first trimester was associated with a 3.7 percentile point decrease in birth weight for gestational age (95% confidence interval [CI] = -6.8 to -0.6). This association appeared stronger for women "keeping house" or with <12 years education. Exposure in the first trimester was also associated with increased odds of SGA (odds ratio = 1.5 [95% CI = 1.1 to 2.1]) and term SGA (odds ratio = 1.6 [95% CI = 1.2 to 2.3]). CONCLUSIONS: Unexpected economic contraction during early pregnancy may be associated with reduced fetal growth.

Association of maternal gestational weight gain with short- and long-term maternal and child health outcomes.

OBJECTIVE: The purpose of this study was to investigate the associations between gestational weight gain (GWG) and small- and large-for-gestational-age (SGA, LGA), cesarean delivery, child overweight, and maternal postpartum weight retention in a diverse sample of women in the Unites States. STUDY DESIGN: We estimated associations between GWG (continuous and within categories defined by the Institute of Medicine), maternal prepregnancy body mass index, and each outcome in 4496 births in the National Longitudinal Survey of Youth 1979, which was a prospective cohort. RESULTS: GWG (kilograms) was associated with decreased risk of SGA and increased risk of LGA, cesarean delivery, postpartum weight retention, and child overweight independent of maternal demographic and pregnancy characteristics. Gain above the Institute of Medicine guidelines was associated with decreased risk of SGA and increased risk of all other outcomes. CONCLUSION: Excessive gain may have long-term consequences for maternal and child body size, but the benefits of lower gain must be balanced against risk of SGA.

Preterm delivery trends by maternal race/ethnicity in the United States, 2006-2012.

PURPOSE: To estimate changes in preterm delivery (PTD) in the United States from 2006 to 2012 by clinical circumstance, timing of delivery, and race/ethnicity. METHODS: We used vital statistics natality data on all singleton live births from the 18 U.S. states continuously using the 2003 birth certificate from 2006 to 2012. We estimated change in PTD overall and by clinical circumstance (spontaneous vs. medically indicated) and delivery timing among all women and by race/ethnicity, using descriptive and multivariable regression methods. RESULTS: Overall, indicated, and spontaneous PTD declined by 10.31%, 8.40%, and 11.52%, respectively. Late-preterm, early-term, and post-term deliveries decreased substantially (12.13%, 18.37%, and 32.20%, respectively), with simultaneous increase (13.57%) in full-term deliveries. Non-Hispanic white, non-Hispanic black, and Asian/Pacific Islander women experienced larger declines in PTD compared with Hispanic and American Indian/Alaska Native women. Non-Hispanic white women experienced larger declines in late and medically indicated PTD, while non-Hispanic black women experienced larger declines in early and moderate and spontaneous PTD. CONCLUSIONS: Overall, spontaneous, and indicated PTD declined from 2006 to 2012. Declines were lower than previously reported and differed substantially by race/ethnicity.

Long-term neighborhood poverty trajectories and obesity in a sample of california mothers.

Neighborhoods (and people) are not static, and are instead shaped by dynamic long-term processes of change (and mobility). Using the Geographic Research on Wellbeing survey, a population-based sample of 2339 Californian mothers, we characterize then investigate how long-term latent neighborhood poverty trajectories predict the likelihood of obesity, taking into account short-term individual residential mobility. We find that, net of individual and neighborhood-level controls, living in or moving to tracts that experienced long-term low poverty was associated with lower odds of being obese relative to living in tracts characterized by long-term high poverty.

Post-term birth as a response to environmental stress : The case of September 11, 2001.

BACKGROUND AND OBJECTIVES: Despite growing interest in the role of maternal psychosocial stress as a determinant of preterm birth, no existing work has examined the relation between maternal stress and post-term birth (≥42 weeks). We hypothesize that prolonging gestation past term may represent an adaptive strategy to a suboptimal environment. METHODOLOGY: We examined the relationship between exposure to the September 2001 terrorist attacks and odds of post-term birth in California. We calculated the expected odds of post-term birth among conception cohorts of singleton gestations in California between October 1996 and November 2005. We used time series analysis to test for higher than expected odds of post-term birth among the 10 cohorts exposed to the attacks of September 2001 (those conceived from December 2000 to September 2001). RESULTS: The observed odds of post-term delivery among gestations at 33-36 weeks in September 2001 were higher than statistically expected for all race/ethnic and sex groups. CONCLUSIONS AND IMPLICATIONS: Our finding that odds of post-term birth were higher than expected among pregnancies exposed to the September 2001 terrorist attacks in late gestation provides initial support for the hypothesis that exposure to a psychosocial stress during pregnancy may result in prolonged gestation.