The association between neighbourhoods and adverse birth outcomes: A systematic review and meta-analysis of multi-level studies

Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada.
Paediatric and Perinatal Epidemiology (Impact Factor: 3.13). 05/2011; 25(3):236-45. DOI: 10.1111/j.1365-3016.2011.01192.x
Source: PubMed


Many studies have examined the role of neighbourhood environment on birth outcomes but, because of differences in study design and modelling techniques, have found conflicting results. Seven databases were searched (1900-2010) for multi-level observational studies related to neighbourhood and pregnancy/birth. We identified 1502 articles of which 28 met all inclusion criteria. Meta-analysis was used to examine the association between neighbourhood income and low birthweight. Most studies showed a significant association between neighbourhood factors and birth outcomes. A significant pooled association was found for the relationship between neighbourhood income and low birthweight [odds ratio = 1.11, 95% confidence interval: 1.02, 1.20] whereby women who lived in low income neighbourhoods had significantly higher odds of having a low birthweight infant. This body of literature was found to consistently document significant associations between neighbourhood factors and birth outcomes. The consistency of findings from observational studies in this area indicates a need for causal studies to determine the mechanisms by which neighbourhoods influence birth outcomes.

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    • "The first is the popularization of multilevel statistical models and the ability to separate the individual-level effects from those of their encompassing social and physical environments [20] [21] [22] [23] [24] [25] [26]. The second is the emerging research on the biological effects of psychosocial stress on health and its modification by environmental factors. "
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    ABSTRACT: Exposure to particulate air pollution and socioeconomic risk factors are shown to be independently associated with adverse pregnancy outcomes; however, their confounding relationship is an epidemiological challenge that requires understanding of their shared etiologic pathways affecting fetal-placental development. The purpose of this paper is to explore the etiological mechanisms associated with exposure to particulate air pollution in contributing to adverse pregnancy outcomes and how these mechanisms intersect with those related to socioeconomic status. Here we review the role of oxidative stress, inflammation and endocrine modification in the pathoetiology of deficient deep placentation and detail how the physical and social environments can act alone and collectively to mediate the established pathology linked to a spectrum of adverse pregnancy outcomes. We review the experimental and epidemiological literature showing that diet/nutrition, smoking, and psychosocial stress share similar pathways with that of particulate air pollution exposure to potentially exasperate the negative effects of either insult alone. Therefore, socially patterned risk factors often treated as nuisance parameters should be explored as potential effect modifiers that may operate at multiple levels of social geography. The degree to which deleterious exposures can be ameliorated or exacerbated via community-level social and environmental characteristics needs further exploration.
    Journal of Environmental and Public Health 11/2014; 2014. DOI:10.1155/2014/901017
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    • "Differential exposure to such stressors that may be more common in racially or socioeconomically disadvantaged groups may lead to gradients in health outcomes along racial or socioeconomic lines. Less is known about the biological mechanisms by which exposure to such stressors affect health and functioning (Metcalfe et al., 2011). Allostatic load is a theoretical construct that represents dysregulation across the body's multiple physiological systems responsible for maintaining equilibrium when faced with physical or social challenges (McEwen, 1998). "
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    ABSTRACT: Large disparities in adverse birth outcomes persist between African American and white women in the US despite decades of research, policy, and public health intervention. Allostatic load is an index of dysregulation across multiple physiologic systems that results from chronic exposure to stress in the physical and socio-cultural environment which may lead to earlier health deterioration among racially or socio-economically disadvantaged groups. The purpose of this investigation was to examine relationships between maternal biomarkers of allostatic load prior to conception and the occurrence of preterm birth and small for gestational age infants among a cohort of white and African American women participants in the Bogalusa Heart Study. Data from women participants were linked to the birth record of their first-born infant. Principal components analysis was used to construct an index of allostatic load as a summary of the weighted contribution of nine biomarkers representing three physiologic domains: cardiovascular, metabolic, and immune systems. A series of Poisson regression models based on samples ranging from 1467 to 375 women were used to examine race, individual biomarkers of allostatic load, and quartiles of the allostatic load index as predictors of preterm birth (n = 150, 10.2%) and small for gestational age (n = 135, 9.2%). There was no evidence of a relationship between maternal preconception allostatic load and either adverse birth outcome in this sample. Further, there was no evidence of effect modification of by race or education. More work is needed in understanding the biological mechanisms linking social inequities to racial disparities in adverse birth outcomes.
    Paediatric and Perinatal Epidemiology 10/2013; 27(6). DOI:10.1111/ppe.12091 · 3.13 Impact Factor
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    • "Preterm birth is related to individual social factors, including maternal education, occupation and ethnicity [1,2], as well as neighbourhood social characteristics [1,3]. The influence of these factors seems to be greater for very preterm births (<32 weeks) than for moderately preterm births (32-36 weeks) [4-7]. "
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    ABSTRACT: Background Social factors affect the risk of very preterm birth and may affect subsequent outcomes in those born preterm. We assessed the influence of neighbourhood socio-economic characteristics on the risk and outcomes of singleton very preterm birth (<32 weeks of gestation) in two European regions with different health systems. Methods Live births (n=1118) from a population-based cohort of very preterm infants in 2003 in Trent (UK) and Ile-de-France (France) regions were geocoded to their neighbourhood census tracts. Odds ratios for very preterm singleton birth by neighbourhood characteristics (unemployment rate, proportion manual workers, proportion with high school education only, non home ownership) were computed using infants enumerated in the census as a control population. The impact of neighbourhood variables was further assessed by pregnancy and delivery characteristics and short term infant outcomes. Results Risk of very preterm singleton birth was higher in more deprived neighbourhoods in both regions (OR between 2.5 and 1.5 in the most versus least deprived quartiles). No consistent associations were found between neighbourhood deprivation and maternal characteristics or health outcomes for very preterm births, although infants in more deprived neighbourhoods were less likely to be breastfed at discharge. Conclusions Neighbourhood deprivation had a strong consistent impact on the risk of singleton very preterm birth in two European regions, but did not appear to be associated with maternal characteristics or infant outcomes. Differences in breastfeeding at discharge suggest that socio-economic factors may affect long term outcomes.
    BMC Pregnancy and Childbirth 04/2013; 13(1):97. DOI:10.1186/1471-2393-13-97 · 2.19 Impact Factor
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