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J Desireddi, J Watson, K Rankin, R David, J Collins, Jr.

Testing a Developmental Origins Model of African-American Women’s Reproductive Outcome: the Effect of Fetal Exposure to Neighborhood Poverty. J Desireddi, J Watson, K Rankin, R David, J Collins, Jr. Department of Pediatrics, Feinberg School of Medicine, Northwestern University, Chicago, IL.

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J Desireddi, J Watson, K Rankin, R David, J Collins, Jr.

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  1. Testing a Developmental Origins Model of African-American Women’s Reproductive Outcome: the Effect of Fetal Exposure to Neighborhood Poverty J Desireddi, J Watson, K Rankin, R David, J Collins, Jr. Department of Pediatrics, Feinberg School of Medicine, Northwestern University, Chicago, IL.

  2. Background • The infant mortality rate of African-Americans is more than twice that of Whites. • Healthy People 2010 calls for the elimination of the racial disparity in infant mortality rates. • Low birth weight (< 2500g, LBW) is a leading determinant of first year mortality risk and is the primary factor underlying the racial disparity in infant mortality rates. • Traditional sociodemographic, medical, and behavioral risk factors fail to explain the racial disparity in LBW rates.

  3. Background: Changing Analysis of Race and Birth Outcome • Old research paradigm: there is a set of social or environmental risk factors that differ in quantity between races but exert similar effects on African Americans and Whites. • New research paradigm: there is a set of social and environmental risk factors that exists only among African Americans.

  4. White Reproductive Potential Risk Factors African American Protective Factors Life Course 0 5ys Puberty Pregnancy Racial Gap in Reproductive Potential: A Life-Course Perspective Lu, Halfon etal, 2003

  5. Research Hypothesis African American women’s in utero exposure to neighborhood poverty is an independent risk factor for poor adult reproductive outcome.

  6. Methods • Obtained the 1989 - 1991 computerized birth certificates of African-American, singleton infants born to Chicago residents. • Based on mother’s full maiden name and exact date of birth, linked 79% (N=42,063) of maternal birth records (1956-1976) for AA. • Due to invalid data for residential geography in 1972, data were excluded for women born in that year. • Appended 1990 US census income data to each infant record. • Appended 1960 US census income data to each maternal record from 1956 to 1965 and 1970 US census income data to maternal record for 1966 through 1976.

  7. Methods • Census tract median family income was empirically divided into quartiles. • Poor 25% – Medium 50% – Affluent 25% • Neighborhood socioeconomic status (SES) was determined at two points in woman’s life • Time of her birth • Time of her pregnancy • Maternal variables: birth weight, prenatal care usage, and maternal education • Infant low birth weight (<2500g, LBW) rates were calculated.

  8. AA Mothers born from 1956-1976:Where did they live when they had babies (89-91)1956-1976 1956-1976 Poor Medium and Affluent Neighborhoods Neighborhoods (48%) (52%)

  9. African American Mothers’ In Utero Residential Environment and Infant LBW Rates

  10. African American Mothers’ Adulthood Residential Environment and Infant LBW Rates

  11. African American Mothers’ Lifetime Residential Environment and Infant LBW Rates

  12. Binomial Regression Models

  13. Is the association between maternal in utero residential environment and infant LBW mediated and/or modified by maternal birth weight?

  14. African American Mothers’ In Utero Residential Environment and Maternal LBW Rates

  15. Infant LBW Rates by Maternal Birth Weight

  16. Binomial Regression Models

  17. Binomial Regression Models

  18. Binomial Regression • The raw and adjusted (controlling for adult neighborhood SES, maternal birth weight, prenatal care, and education attainment) RR of infant LBW for maternal in utero exposure to neighborhood poverty were 1.21 and 1.21, respectively. • The raw and adjusted (controlling for maternal in utero and adult neighborhood SES, prenatal care, and education attainment) RR of infant LBW for maternal LBW were 1.5 and 1.47. respectively.

  19. Conclusions(African-Americans) • Maternal in utero residence in poor neighborhoods is a modest risk factor for infant LBW. • Aberrant female in utero experiences (as measured by LBW) is associated with poor adult reproductive outcome independent of adult risk status. • These findings are consistent with a developmental origins conceptual model of adult reproductive outcome.

  20. Acknowledgments • James W. Collins, MD, MPH • Richard David, MD • Kristin Rankin, MSPH, PhD Candidate • Julie Watson, MD

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