To evaluate the mediating role of social and environmental determinants of health (SEDH) in the relationship between self-identified race and preterm birth risk.
Methods:
Data on birth outcomes and five broad domains of SEDH were obtained from the Pregnancy, Race, Environment, Genes study, a prospective cohort of pregnant women (50% Black American) in Richmond, Virginia. Configural consistency across racial groups for SEDH domains assessed via multiple indicators was evaluated using unidimensional confirmatory factor models. Mediation models tested the extent to which individual variables/constructs and broader SEDH domains accounted for the association between self-identified race and gestational age at delivery (GAD).
Results:
Economic Stability, Education, Health/Health Care, and Social/Community Context showed evidence of mediation through one or more specific subdimensions. Education and Economic Stability fully mediated the association between race and GAD, indexed by maternal educational attainment and current job duration, respectively. In contrast, consideration of Social/Community Context exposed an even larger association between race and GAD.
Conclusions:
This study highlights the role of specific and broader SEDH domains in the association between race and spontaneous preterm birth (PTB) risk. Findings underscore the significant impact of educational access and economic security on reproductive outcomes.
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References
1.
YorkTP, StraussJF, NealeMC, et al.Racial differences in genetic and environmental risk to preterm birth. PLoS One, 2010; 5(8):e12391.
2.
CostaDL. Race and Pregnancy outcomes in the twentieth century: A long-term comparison. J Econ Hist, 2004; 64(4):1056–1086.
3.
GoldenbergRL, CulhaneJF, IamsJD, et al.Epidemiology and causes of preterm birth. Lancet, 2008; 371(9606):75–84.
4.
BehrmanRE, ButlerAS. Preterm Birth: Causes, Consequences, and Prevention. Academy Press: Washington, D.C.; 2007.
5.
CarterMF, XenakisE, HoldenA, et al.Neonatal intensive care unit admissions and their associations with late preterm birth and maternal risk factors in a population-based study. J Matern Fetal Neonatal Med, 2012; 25(4):343–345.
6.
LawnJE, CousensS, ZupanJ, Lancet Neonatal Survival Steering Team. 4 million neonatal deaths: When? Where? Why? Lancet, 2005; 365(9462):891–900.
7.
CallaghanWM, MacDormanMF, RasmussenSA, et al.The contribution of preterm birth to infant mortality rates in the United States. Pediatrics, 2006; 118(4):1566–1573.
8.
DongY, YuJ-L. An overview of morbidity, mortality and long-term outcome of late preterm birth. World J Pediatr, 2011; 7(3):199–204.
9.
KistkaZA, DeFrancoEA, LigthartL, et al.Heritability of parturition timing: An extended twin design analysis. Am J Obstet Gynecol, 2008; 199(1):43.e1–43.e5.
10.
MenonR, VelezDR, ThorsenP, et al.Ethnic differences in key candidate genes for spontaneous preterm birth: TNF-alpha and its receptors. Hum Hered, 2006; 62(2):107–118.
11.
DavidR, CollinsJ.Jr., Disparities in infant mortality: What’s genetics got to do with it? Am J Public Health, 2007; 97(7):1191–1197.
12.
YorkTP, EavesLJ, LichtensteinP, et al.Fetal and maternal genes’ influence on gestational age in a quantitative genetic analysis of 244,000 Swedish births. Am J Epidemiol, 2013; 178(4):543–550.
13.
LundeA, MelveKK, GjessingHK, et al.Genetic and environmental influences on birth weight, birth length, head circumference, and gestational age by use of population-based parent-offspring data. Am J Epidemiol, 2007; 165(7):734–741.
14.
YorkTP, StraussJF, NealeMC, et al.Estimating fetal and maternal genetic contributions to premature birth from multiparous pregnancy histories of twins using MCMC and maximum-likelihood approaches. Twin Res Hum Genet, 2009; 12(4):333–342.
15.
YorkTP, EavesLJ, NealeMC, et al.The contribution of genetic and environmental factors to the duration of pregnancy. Am J Obstet Gynecol, 2014; 210(5):398–405.
16.
KwapongYA, BoakyeE, ObisesanOH, et al.Nativity-Related Disparities in preterm birth and cardiovascular risk in a multiracial U.S. cohort. Am J Prev Med, 2022; 62(6):885–894.
17.
RuizRJ, MartiCN, PicklerR, et al.Acculturation, depressive symptoms, estriol, progesterone, and preterm birth in Hispanic women. Arch Womens Ment Health, 2012; 15(1):57–67.
18.
LaraM, GamboaC, KahramanianMI, et al.Acculturation and latino health in the United States: A review of the literature and its sociopolitical context. Annu Rev Public Health, 2005; 26(1):367–397.
19.
FloresMES, SimonsenSE, ManuckTA, et al.The “Latina Epidemiologic Paradox”: Contrasting patterns of adverse birth outcomes in U.S.-born and foreign-born latinas. Womens Health Issues, 2012; 22(5):e501–e507.
20.
PremkumarA, DebbinkMP, SilverRM, et al.Association of acculturation with adverse pregnancy outcomes. Obstet Gynecol, 2020; 135(2):301–309.
21.
DeSistoCL, HiraiAH, CollinsJWJr, et al.Deconstructing a disparity: Explaining excess preterm birth among U.S.-born black women. Ann Epidemiol, 2018; 28(4):225–230.
22.
DavidRJ, CollinsJW.Jr., Differing birth weight among infants of U.S.-born blacks, African-born blacks, and U.S.-born whites. N Engl J Med, 1997; 337(17):1209–1214.
23.
LhilaA, LongS. What is driving the black-white difference in low birthweight in the US? Health Econ, 2012; 21(3):301–315.
24.
24. of Health USD, Services H, Others. Healthy People 2020: An Opportunity to Address Societal Determinants of Health in the United States. In Secretary’s Advisory Committee on Health Promotion and Disease Prevention Objectives for 2020. 2010.
25.
FiscellaK. Race, genes and preterm delivery. J Natl Med Assoc, 2005; 97(11):1516–1526.
26.
GravleeCC. How race becomes biology: Embodiment of social inequality. Am J Phys Anthropol, 2009; 139(1):47–57.
27.
WadhwaPD, EntringerS, BussC, et al.The contribution of maternal stress to preterm birth: Issues and considerations. Clin Perinatol, 2011; 38(3):351–384.
28.
GrobmanWA, ParkerCB, WillingerM, et al.; Eunice Kennedy Shriver National Institute of Child Health and Human Development Nulliparous Pregnancy Outcomes Study: Monitoring Mothers-to-Be (nuMoM2b) Network*. Racial disparities in adverse pregnancy outcomes and psychosocial stress. Obstet Gynecol, 2018; 131(2):328–335.
29.
BurrisHH, ValeriL, James-ToddT. Statistical methods to examine contributors to racial disparities in perinatal outcomes. Semin Perinatol, 2022; 46(8):151663.
30.
LapatoDM, MoyerS, OlivaresE, et al.Prospective longitudinal study of the pregnancy DNA methylome: The US Pregnancy, Race, Environment, Genes (PREG) study. BMJ Open, 2018; 8(5):e019721.
BravemanP, DominguezTP, BurkeW, et al.Explaining the Black-white disparity in preterm birth: A Consensus statement from a multi-disciplinary scientific work group convened by the march of dimes. Front Reprod Health, 2021; 3:684207.
VanderbiltAA, WrightMS, BrewerAE, et al.Increasing knowledge and health literacy about preterm births in underserved communities: An approach to decrease health disparities, a pilot study. Glob J Health Sci, 2015; 8(1):83–89.
35.
ShulmanHB, D’AngeloDV, HarrisonL, et al.The Pregnancy Risk Assessment Monitoring System (PRAMS): Overview of design and methodology. Am J Public Health, 2018; 108(10):1305–1313.
36.
GovigB, de SouzaR, LevitanEB, et al.The eating assessment table-an evidence-based nutrition tool for clinicians: Background, description, future of tool. Crit Pathw Cardiol, 2009; 8(2):55–56, 57–62.
37.
ElliottDS, HuizingaD, AgetonSS. Explaining Delinquency and Drug Use. Sage Publications: Beverly Hills, CA; 1985.
38.
SherbourneCD, StewartAL. The MOS social support survey. Soc Sci Med, 1991; 32(6):705–714.
39.
SmilksteinG. The family APGAR: A proposal for a family function test and its use by physicians. J Fam Pract, 1978; 6(6):1231–1239.
40.
KriegerN, SmithK, NaishadhamD, et al.Experiences of discrimination: Validity and reliability of a self-report measure for population health research on racism and health. Soc Sci Med, 2005; 61(7):1576–1596.
41.
MuthenLK, MuthenBO. Mplus: User’s Guide. Muthen and Muthen: Los Angeles, CA; 1998.
42.
DistefanoC, FinneyS. Non-Normal and Categorical Data in Structural Equation Modeling. Structural equation modeling: a second course. 2013.
43.
FloraDB. Your coefficient alpha is probably wrong, but which coefficient omega is right? A tutorial on using r to obtain better reliability estimates. Advances in Methods and Practices in Psychological Science, 2020; 3(4):484–501.
44.
McDonaldRP. The theoretical foundations of principal factor analysis, canonical factor analysis, and alpha factor analysis. Brit J Math & Statis, 1970; 23(1):1–21.
45.
ImaiK, KeeleL, TingleyD. A general approach to causal mediation analysis. Psychol Methods, 2010; 15(4):309–334.
46.
TingleyD, YamamotoT, HiroseK, et al.mediation: R Package for Causal Mediation Analysis. J Stat Soft, 2014; 59(5):1–38.
47.
ChiWE, HuangS, JeonM, et al.A practical guide to causal mediation analysis: Illustration with a Comprehensive College Transition Program and nonprogram peer and faculty interactions. Front Educ, 2022; 7; doi: 10.3389/feduc.2022.886722
48.
LittleRJA, RubinDB. Statistical Analysis with Missing Data. John Wiley & Sons; 2019.
49.
SchaferJL, GrahamJW. Missing data: Our view of the state of the art. Psychol Methods, 2002; 7(2):147–177.
50.
GrobmanWA, ParkerC, WadhwaPD, et al.; Eunice Kennedy Shriver National Institute of Child Health Human Development nuMoM2b Network, Bethesda, MD. Racial/Ethnic disparities in measures of self-reported psychosocial states and traits during pregnancy. Am J Perinatol, 2016; 33(14):1426–1432.
51.
MisraDP, GuyerB, AllstonA. Integrated perinatal health framework. A multiple determinants model with a life span approach. Am J Prev Med, 2003; 25(1):65–75.
52.
CantaruttiA, FranchiM, Monzio CompagnoniM, et al.Mother’s education and the risk of several neonatal outcomes: An evidence from an Italian population-based study. BMC Pregnancy Childbirth, 2017; 17(1):221.
53.
DunlopAL, EssalmiAG, AlvalosL, et al.; program collaborators for Environmental Influences on Child Health Outcomes. 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. PLoS One, 2021; 16(1):e0245064.
54.
YuY, LiewZ, WangA, et al.Mediating roles of preterm birth and restricted fetal growth in the relationship between maternal education and infant mortality: A Danish population-based cohort study. PLoS Med, 2019; 16(6):e1002831.
55.
YeC-X, ChenS-B, WangT-T, et al.Risk factors for preterm birth: A prospective cohort study. Zhongguo Dang Dai Er Ke Za Zhi, 2021; 23(12):1242–1249.
56.
EkekeP, RankinK, DeSistoC, et al.The Excess preterm birth rate among US-Born (Compared to Foreign-Born) black women: The role of father’s education. Matern Child Health J, 2022; 26(4):845–852.
57.
OkuiT. Analysis of an association between preterm birth and parental educational level in Japan using national data. Children (Basel), 2023; 10(2):342; doi: 10.3390/children10020342
58.
WallaceME, MendolaP, LiuD, et al.Joint effects of structural racism and income inequality on small-for-gestational-age birth. Am J Public Health, 2015; 105(8):1681–1688.
59.
DeFrancoEA, LianM, MugliaLA, et al.Area-level poverty and preterm birth risk: A population-based multilevel analysis. BMC Public Health, 2008; 8:316.
60.
BravemanPA, HeckK, EgerterS, et al.The Role of socioeconomic factors in black–white disparities in preterm birth. Am J Public Health, 2015; 105(4):694–702.
61.
GiurgescuC, ZenkSN, DancyBL, et al.Relationships among neighborhood environment, racial discrimination, psychological distress, and preterm birth in African American women. J Obstet Gynecol Neonatal Nurs, 2012; 41(6):E51–E61.
62.
Vinikoor-ImlerLC, MesserLC, EvensonKR, et al.Neighborhood conditions are associated with maternal health behaviors and pregnancy outcomes. Soc Sci Med, 2011; 73(9):1302–1311.
63.
HollenbachSJ, ThornburgLL, GlantzJC, et al.Associations Between historically redlined districts and racial disparities in current obstetric outcomes. JAMA Netw Open, 2021; 4(9):e2126707.
64.
MenonR, MerialdiM, LombardiSJ, et al.Differences in the placental membrane cytokine response: A possible explanation for the racial disparity in preterm birth. Am J Reprod Immunol, 2006; 56(2):112–118.
65.
MountainJL, RischN. Assessing genetic contributions to phenotypic differences among “racial” and “ethnic” groups. Nat Genet, 2004; 36(S11):S48–S53.
66.
RischN, BurchardE, ZivE, et al.Categorization of humans in biomedical research: Genes, race and disease. Genome Biol, 2002; 3(7):comment2007.
67.
RomeroR, DeySK, FisherSJ. Preterm labor: One syndrome, many causes. Science, 2014; 345(6198):760–765.
68.
StraussJF3rd, RomeroR, Gomez-LopezN, et al.Spontaneous preterm birth: Advances toward the discovery of genetic predisposition. Am J Obstet Gynecol, 2018; 218(3):294–314.e2.
69.
KramerMR, HogueCR. What causes racial disparities in very preterm birth? A biosocial perspective. Epidemiol Rev, 2009; 31:84–98.
70.
BurrisHH, CollinsJW.Jr., Race and preterm birth--the case for epigenetic inquiry. Ethn Dis, 2010; 20(3):296–299.
71.
LancasterEE, LapatoDM, Jackson-CookC, et al.Maternal biological age assessed in early pregnancy is associated with gestational age at birth. Sci Rep, 2021; 11(1):15440.
72.
MenonR, ConneelyKN, SmithAK. DNA methylation: An epigenetic risk factor in preterm birth. Reprod Sci, 2012; 19(1):6–13.
73.
Barcelona de MendozaV, WrightML, AgabaC, et al.A systematic review of DNA methylation and preterm birth in African American Women. Biol Res Nurs, 2017; 19(3):308–317.
74.
YorkTP, LatendresseSJ, Jackson-CookC, et al.Replicated umbilical cord blood DNA methylation loci associated with gestational age at birth. Epigenetics, 2020; 15(11):1243–1258.
75.
ParetsSE, ConneelyKN, KilaruV, et al.Fetal DNA Methylation associates with early spontaneous preterm birth and gestational age. PLoS One, 2013; 8(6):e67489.
76.
JainVG, MonangiN, ZhangG, et al.Genetics, epigenetics, and transcriptomics of preterm birth. Am J Reprod Immunol, 2022; 88(4):e13600.
77.
PaquetteAG, MacDonaldJ, BammlerT, et al.Placental transcriptomic signatures of spontaneous preterm birth. Am J Obstet Gynecol, 2023; 228(1):73.e1–73.e18.
78.
SurkanPJ, HongX, ZhangB, et al.Can social support during pregnancy affect maternal DNA methylation? Findings from a cohort of African-Americans. Pediatr Res, 2020; 88(1):131–138.
79.
HongX, BartellTR, WangX. Gaining a deeper understanding of social determinants of preterm birth by integrating multi-omics data. Pediatr Res, 2021; 89(2):336–343.
80.
SmithAK, KilaruV, KocakM, et al.Methylation quantitative trait loci (meQTLs) are consistently detected across ancestry, developmental stage, and tissue type. BMC Genomics, 2014; 15:145.
81.
SalihuHM, DasR, MortonL, et al.Racial differences in DNA-Methylation of CpG sites within preterm-promoting genes and gene variants. Matern Child Health J, 2016; 20(8):1680–1687.
82.
BlumenshinePM, EgerterSA, LibetML, et al.Father’s education: An independent marker of risk for preterm birth. Matern Child Health J, 2011; 15(1):60–67.
83.
BartleyM, MartikainenP, ShipleyM, et al.Gender differences in the relationship of partner’s social class to behavioural risk factors and social support in the Whitehall II study. Soc Sci Med, 2004; 59(9):1925–1936.
84.
BorrellLN, BolúmarF, Rodriguez-AlvarezE, et al.Adverse birth outcomes in New York City women: Revisiting the Hispanic Paradox. Soc Sci Med, 2022; 315:115527.
85.
HardenKP. Genetic determinism, essentialism and reductionism: Semantic clarity for contested science. Nat Rev Genet, 2023; 24(3):197–204.
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