Witt Whitney P, Park Hyojun, Wisk Lauren E, Cheng Erika R, Mandell Kara, Chatterjee Debanjana, Zarak Dakota
At the time of the study, Whitney P. Witt was with Maternal and Child Health Research, Truven Health Analytics, Durham, NC. Hyojun Park, Kara Mandell, and Debanjana Chatterjee were with the Department of Population Health Sciences, School of Medicine and Public Health, University of Wisconsin, Madison. Lauren E. Wisk was with the Center for Child Health Care Studies in the Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA. Erika R. Cheng was with Harvard Medical School and the Division of General Academic Pediatrics at the Massachusetts General Hospital for Children, Boston. Dakota Zarak was with the Department of Psychology, University of Wisconsin, Madison.
Am J Public Health. 2015 May;105(5):1044-52. doi: 10.2105/AJPH.2015.302566. Epub 2015 Mar 19.
We sought to determine whether the effects of preconception stressful life events (PSLEs) on birth weight differed by neighborhood disadvantage.
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.
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.
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.
我们试图确定孕前应激性生活事件（PSLEs）对出生体重的影响是否因邻里劣势而异。
我们从儿童早期纵向研究出生队列（2001 - 2002年；n = 9300）中提取数据。我们使用2000年美国人口普查的县级数据创建了一个邻里劣势指数（NDI）。我们将NDI分为三分位数，分别代表优势邻里、中等优势邻里和劣势邻里。分层多项逻辑回归估计了PSLEs对出生体重的影响，并对混杂因素进行了控制。
我们发现，按NDI三分位数划分，女性暴露于PSLEs与生出极低出生体重（VLBW）婴儿之间的关系存在梯度；这种关联在劣势邻里中最强（调整后的优势比[AOR] = 1.62；95%置信区间[CI] = 1.04, 2.53），其次是中等（AOR = 1.39；95% CI = 1.00, 1.93）和优势（AOR = 1.29；95% CI = 0.91, 1.82）邻里。我们在患有慢性病的女性和少数族裔母亲中也观察到了类似的梯度。
经历过PSLEs、患有慢性病或属于少数种族/族裔的女性，如果生活在劣势邻里中，生出VLBW婴儿的风险最大；这表明在劣势环境中风险会加剧。降低VLBW发生率的干预措施应侧重于减少应激源的有害影响并改善邻里条件。
