Claire E. Margerison

Michigan State University | MSU · Department of Epidemiology

Background: Nearly half of all pregnancies in the United States are considered unintended (mistimed or unwanted), and this rate is even higher among younger and lower income women. The Affordable Care Act (ACA) dependent coverage provision may have influenced the frequency of unintended pregnancies by increasing accessibility to and affordability o...

Importance Prior observational research has shown that infants born in states with more abortion restrictions are more likely to die during infancy. It is unclear how recent and more severe abortion bans in the US have impacted infant mortality. Objective To examine whether Texas Senate Bill 8 (SB8), which banned abortions after embryonic cardiac...

Epidemiologists have long argued that side effects of the stress response include preterm birth. Research reports that fear of lethal infection stressed pregnant persons at the outset of the COVID-19 pandemic and that "shutdowns" and "social distancing" impeded access to social support and prenatal care. The decline in preterm births in high-income...

Objectives. To examine changes in cause-specific pregnancy-associated deaths during the COVID-19 pandemic by race and ethnicity and assess changes in racial and ethnic inequities in pregnancy-associated deaths. Methods. We used US vital statistics mortality data from 2018 to 2021 to identify pregnancy-associated deaths among females aged 15 to 44 y...

Background: Despite including several provisions focused on American Indian and Alaska Native (AI/AN) people, few studies look at the Affordable Care Act (ACA)'s potential impact among AI/AN birth givers, a group that experiences a disproportionate burden of adverse pregnancy outcomes. While ACA repeal conversations are ongoing, our objective was t...

In the United States, there are profound and persistent racial and ethnic disparities in pregnancy-related health, emphasizing the need to promote racial health equity through public policy. There is evidence that the Affordable Care Act (ACA) increased health insurance coverage, access to health care, and health care utilization, and may have affe...

Background: Racial and socioeconomic status (SES) disparities in preterm delivery (PTD) have existed in the United States for decades. Disproportionate maternal exposures to adverse childhood experiences (ACEs) may increase the risk for adverse birth outcomes. Moreover, racial and SES disparities exist in the prevalence of ACEs, underscoring the ne...

Importance: Infants and pregnant people in the US fare worse on almost all health measures compared with those in peer nations. Families in the US are more likely to live in poverty and have a less generous social safety net, which has generated debate over the contribution of economic conditions to this disparity. Objective: To assess the assoc...

The objective of this study was to systematically review the available empirical evidence examining associations between preterm birth (PTB) and five domains of place-based contextual social and environmental determinants, including (1) physical environment, (2) residential greenness, (3) neighborhood violence/crime, (4) food accessibility and avai...

This cross-sectional study assesses changes in pregnancy-associated mortality from drug overdose, homicide, suicide, and other causes in the US from 2018 through 2020.

Maternal mortality and morbidity in the United States are high compared with those in similar countries, and racial/ethnic disparities exist, with many of these events occurring in the later postpartum period. Proposed federal and recently enacted state policy interventions extend pregnancy Medicaid from covering 60 days to a full year postpartum....

Background: Although preventable through screening, cervical cancer incidence and mortality are higher among American Indian and Alaska Native women (AIAN) than White women. The Patient Protection and Affordable Care Act's (ACA) Medicaid expansions may uniquely impact access and use of cervical cancer screening among AIAN women and ultimately alle...

Objective: To explore population-level American Indian & Alaska Native-White inequalities in cesarean birth incidence after accounting for differences in cesarean indication, age, and other individual-level risk factors. Data sources & study setting: We used birth certificate data inclusive of all live births within the United States between Jan...

Liberalized state-level recreational cannabis policies in the United States (US) fostered important policy evaluations with a focus on epidemiological parameters such as proportions [e.g., active cannabis use prevalence; cannabis use disorder (CUD) prevalence]. This cannabis policy evaluation project adds novel evidence on a neglected parameter–nam...

Background: The United States (US) data suggest fewer-than-expected preterm births in 2020, but no study has examined the impact of exposure to the early COVID-19 pandemic at different points in gestation on preterm birth. Objective: Our objective was to determine-among cohorts exposed to the early COVID-19 pandemic-whether observed counts of ov...

Background: Non-Hispanic Black (“Black”) women in the United States deliver preterm at persistently higher rates than non-Hispanic White (“White”) women, and disparities in preterm delivery (PTD) also exist by socioeconomic factors. Research is needed to identify and understand factors that are protective against PTD for Black women and low socioec...

Introduction High and increasing levels of pregnancy-related mortality and morbidity in the U.S. indicate that the underlying health status of reproductive-aged women may be far from optimal, yet few studies have examined mortality trends and disparities exclusively among this population. Methods All-cause and cause-specific mortality data for 199...

Liberalized state-level recreational cannabis policies in the United States (US) fostered important policy evaluations with a focus on epidemiological parameters such as proportions [e.g., active cannabis use prevalence proportions; cannabis use disorder (CUD) prevalence]. This cannabis policy evaluation project adds novel evidence on a neglected p...

Background: We hypothesize that the Affordable Care Act's (ACA) Medicaid expansion, which extended health insurance coverage to pre-conception, between-conception, and post-conception periods for women meeting income eligibility guidelines, impacted the number of live births in the US, by increasing access to contraception and financial wellbeing....

Objective: To estimate the prevalence of pregnancy-associated deaths due to drugs, suicide, and homicide nationwide from 2010 to 2019. Methods: Using U.S. death certificate records from 2010 to 2019 for 33 states plus the District of Columbia, we identified pregnancy-associated deaths using the pregnancy checkbox and International Classification...

Poor perinatal mental health is a common pregnancy-related morbidity with potentially serious impacts that extend beyond the individual to their family. A possible contributing factor to poor perinatal mental health is discontinuity in health insurance coverage, which is particularly important among low-income people. We examined impacts of Medicai...

Background: Non-Hispanic Black (NHB) women face a 50% increased risk of delivering preterm compared to non-Hispanic White (NHW) women in the United States. Sociodemographic and pregnancy risk factors do not fully explain this inequity. This inequity exists even among women with a college education, although recent empirical analysis on racial ineq...

Preconception healthcare is heralded as an essential method of improving pregnancy health and outcomes. However, access to healthcare for low-income women of reproductive age has been limited because of a lack of health insurance. Expansions of Medicaid eligibility under the Affordable Care Act (as well as prior expansions in some states) have chan...

Introduction: Preconception and interconception health care are critical means of identifying, managing, and treating risk factors originating before pregnancy that can harm fetal development and maternal health. However, many women in the U.S. lack health insurance, limiting their ability to access such care. State-level variation in Medicaid eli...

Objective: (s): The contraception mandate of the Affordable Care Act (ACA) could reduce unintended pregnancies by increasing access and affordability of contraceptive resources, such as long-acting reversible contraceptives (LARCs). The objective of this study was to assess: (1) whether unintended pregnancies decreased following the contraception...

Objectives To describe the creation of a multigenerational linked dataset with social mobility measures for South Carolina (SC), as an example for states in the South and other areas of the country. Methods Using unique identifiers, we linked birth certificates along the maternal line using SC birth certificate data from 1989 to 2014, and compared...

Background: Reducing maternal mortality is a priority in the United States and worldwide. Drug-related deaths and suicide may account for a substantial and growing portion of maternal deaths, yet information on the incidence of and sociodemographic variation in these deaths is scarce. Objective: We sought to examine incidence of drug-related and...

Causal evidence regarding neighborhood effects on health remains tenuous. Given that children have little agency in deciding where they live and spend proportionally more of their lives in neighborhoods than adults, their exposure to neighborhood conditions could make their health particularly sensitive to neighborhood effects. In this paper, we ex...

Objective Suicide mortality rates in rural areas of the United States are twice that of rates in urban areas, and identifying which factors—eg, higher rates of suicidal distress, lower rates of help‐seeking behaviors, or greater access to firearms—contribute to this rural/urban disparity could help target interventions. Method Using 2015‐2016 data...

Background Making causal inference regarding impacts of macrolevel economic conditions during pregnancy on pregnancy outcomes is hampered by the presence of unmeasured variables that may influence women's probability of giving birth under certain economic conditions (ie, exposure) as well as her pregnancy outcomes. Maternal fixed‐effects (FE) analy...

Objective Growing evidence suggests that maternal socioeconomic mobility (SM) is associated with pregnancy outcomes. Our study investigated the association between maternal SM from childhood to adulthood and the risk of preterm delivery (PTD), and examined heterogeneity of associations by race/ethnicity. Methods In this study, 3019 pregnant women e...

Objectives: Investigate adverse birth outcomes in the United States (US) from 1989–2013 in relation to paternal and maternal race/ethnicity. Design: We used US natality data for singleton births to women 15–44 with information on birthweight, gestational age, and covariates (n = 90,771,339). We calculated unadjusted and adjusted probabilities of pr...

Objectives Investigate adverse birth outcomes in the United States (US) from 1989–2013 in relation to paternal and maternal race/ethnicity. Design We used US natality data for singleton births to women 15–44 with information on birthweight, gestational age, and covariates (n = 90,771,339). We calculated unadjusted and adjusted probabilities of pre...

Objective: Studies of maternal serum uric acid (UA) in pregnancy focus primarily on high levels of UA, however, both low and high UA levels can be markers of oxidative stress, a biological state potentially linked to fetal growth. We therefore aimed to test whether low and high maternal serum UA levels during pregnancy are associated with atypical...

Background: The black-white disparity in hypertension (HTN) among U.S. women persists after accounting for known risk factors. Pregnancy complications may reveal increased risks for later HTN. We examined the contribution of HTN risk factors measured at both midlife and pregnancy to black-white disparities in midlife HTN. Methods: Data came from...

(Abstracted from Am J Epidemiol 2017;186(10):1131–1139) Although there exists a plethora of evidence on the adverse adult health effects of negative macroeconomic change, little is known about the effects of macroeconomic change on birth outcomes. This association is inherently difficult to discern, given the lack of state- and time-specific data a...

Background: Prior studies indicate associations between preconception adversities and risk of miscarriage, but few have considered type (e.g., financial, substance use, abuse) or timing (e.g., childhood, adulthood) of adversities. We examined relationships between life course adversities in multiple domains and probability of miscarriage. Methods...

Objectives To determine whether historical neighborhood poverty measures are associated with mothers' reports of their children's sleep duration and to compare results from historical neighborhood poverty measures to contemporaneous measures of neighborhood poverty. Design The Geographic Research on Wellbeing (GROW) study is a follow-up survey of...

Objective: Studies find both very low and high serum uric acid (UA) levels are related to oxidative stress and to conditions such as cardiovascular diseases and chronic kidney disease in the general population. Pregnancy studies have focused only on high maternal UA. In present study, we tested whether unusually high and low levels of maternal ser...

Background: The beneficial effect of breastfeeding on individual components of the metabolic syndrome in children and adolescents has been reported, but it is unknown if there is an association between being breastfed and metabolic syndrome as a whole. Research aim: This systematic review was performed to assess quality and strength of evidence fo...

Place: necessarily encompasses all social contexts to which females are exposed from infancy through young adulthood; encompasses a variety of related exposures that, when possible, should be jointly considered; and may compound the effect of poverty-in childhood, adolescence, or young adulthood-on perinatal health. Social relationships: span rela...

Social class gradients in children’s health and development are ubiquitous across time and geography. The authors develop a conceptual framework relating three actions of class—material allocation, salient group identity, and inter-group conflict—to the reproduction of class-based disparities in child health. A core proposition is that the actions...

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 PT...

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...

( Am J Obstet Gynecol. 2016;215(4):406–407) Cardiovascular disease (CVD) is the leading cause of mortality among women, but because CVD presents differently in women than in men, traditional methods of early detection are insufficient. In addition, knowledge of CVD in women of reproductive age is lacking. It is known that women with small for gesta...

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...

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...

Background We examine the association between the poverty histories of neighbourhoods and three indicators of psychosocial well-being—depressive symptoms, sense of control and number of stressors—in an observational study of mothers of young children in California. We also consider if length of residence in a neighbourhood moderates the association...

Prior research examining links between neighborhood violence and mental health has not been able to establish whether it is perceived levels of neighborhood violence, or actual levels of violent crime, that matter most for adolescents’ psychological well-being. In this study, we ascertained both perceived neighborhood safety and objectively-measure...

The severity, sudden onset, and multipronged nature of the Great Recession (2007–2009) provided a unique opportunity to examine the health impacts of macroeconomic downturn. We comprehensively review empirical literature examining the relationship between the Recession and mental and physical health outcomes in developed nations. Overall, studies r...

Researchers often examine neighborhood socioeconomic environment and health during the perinatal period using geocoded addresses recorded on birth certificates at the time of delivery. Our objective was to assess the potential for post-partum neighborhood misclassification by examining whether women move neighborhoods during the immediate post-part...

Objectives The “dysregulated parturition” narrative posits that the human stress response includes a cascade of hormones that “dysregulates” and accelerates parturition but provides questionable utility as a guide to understand or prevent preterm birth. We offer and test a “strategic parturition” narrative that not only predicts the excess preterm...

We examined associations between longitudinal neighborhood poverty trajectories and preterm birth (PTB). Using data from the Neighborhood Change Database (1970-2000) and the American Community Survey (2005-2009), we categorized longitudinal trajectories of poverty for California neighborhoods (i.e., census tracts). Birth data included 23 291 single...

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. Meth...

Purpose The purpose of this study was to examine associations between maternal exposure to unexpected economic contraction and health behaviors during pregnancy, using methods to account for impacts of economic contraction on selection into pregnancy. Methods Data on health behaviors among 7,074 pregnancies in the National Longitudinal Survey of Y...

Background After decades of steady increase, mean birthweight in the US declined throughout the 1990s and early 2000s, a trend not fully explained by changes in length of gestation, medical practice, demographics, or maternal behaviours. We hypothesised that secular changes in health or social factors across women's life courses may have contribute...

Background: Researchers are increasingly interested in using geocoded addresses from birth records or post-partum surveys (e.g., Pregnancy Risk Assessment Monitoring System [PRAMS]) to investigate how neighborhood factors such as socioeconomic status (SES) impact perinatal health. However, evidence suggests that 13 to 41 percent of women move durin...

Background. Racial/ethnic disparities in depressive symptoms during pregnancy are substantial. Given that socioeconomic factors are related to depression and that there are tremendous differences in socioeconomic factors according to race/ethnicity, we hypothesized that racial/ethnic disparities in depressive symptoms would be eliminated for women...

Background. Neighborhood poverty is associated with increased risk of preterm birth (PTB); however, most of this research uses cross-sectional measures of neighborhood poverty. We hypothesize that the longitudinal poverty experience of a neighborhood may influence factors important to perinatal health such as psychosocial stress or access to health...

Objective To examine the associations between poverty dynamics and the long-term risk of developing overweight or obesity. Design and methods Our data are a representative sample of U.S. children from the National Longitudinal Survey of Youth 1979 Child and Young Adult Survey (1986-2008). We used survival analysis to compare risk of developing ove...

Objectives: Alcohol outlet density has long been associated with alcohol-related harms, and policymakers have endorsed alcohol outlet restriction to reduce these harms. However, potential nonlinearity in the relation between outlet density and alcohol consumption has not been rigorously examined. Methods: We used data from the New York Social En...

Evolutionary theory, when coupled with research from epidemiology, demography, and population endocrinology, suggests that contracting economies affect the fitness and health of human populations via natural selection in utero. We know, for example, that fetal death increases more among males than females when the economy unexpectedly contracts; th...

Introduction: Existing research documents strong inverse socioeconomic gradients in current smoking and lung cancer morbidity and mortality; these gradients appear stronger among non-Hispanic Whites and Blacks compared with Hispanics. We sought to examine a broader range of outcomes across the tobacco use continuum, examining socioeconomic gradien...

Previous research suggests that neighborhoods in the United States with high concentrations of poverty or of racial/ethnic minorities have lower access to healthy foods and greater access to unhealthy foods, compared with higher income or predominantly White, non-Hispanic neighborhoods. Lower access is thought to influence dietary habits and result...

Research has documented an inverse gradient relationship between current smoking and education; this gradient is most apparent among non-Hispanic whites compared to other race/ethnic groups. Little is known about the education gradient for other tobacco-related indicators, both overall and within race/ethnic groups. Using the 2010 National Health I...

Antagonists in the debate over whether the maternal stress response during pregnancy damages or culls fetuses have invoked the theory of selection in utero to support opposing positions. We describe how these opposing arguments arise from the same theory and offer a novel test to discriminate between them. Our test, rooted in reports from populatio...

The argument that women in stressful environments spontaneously abort their least fit fetuses enjoys wide dissemination despite the fact that several of its most intuitive predictions remain untested. The literature includes no tests, for example, of the hypothesis that these mechanisms select against small for gestational age (SGA) males. We apply...

The macro-level economy may affect fetal health through maternal behavioral or physiologic responses. 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 Na...

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...

Several studies in low-income populations report the somewhat counterintuitive finding that positive income gains adversely affect adult health. The literature posits that receipt of a large portion of annual income increases, in the short term, risk-taking behaviour and/or the consumption of health-damaging goods. This work implies the hypothesis...

BACKGROUND Previous research has demonstrated an association between economic contraction at both the individual and aggregate level, and adverse health outcomes. Proposed mechanisms include increased psychosocial stress and loss of resources. The aim of this review is to assess the quantity, validity and consistency of empirical evidence examining...

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. We estimated associations between GWG (continuous and within categor...

Most research describing the biological response to unemployment appears appropriately motivated by clinical or public health concerns and focuses on death, disease, and medical care. We argue that expanding the work to include other outcomes could contribute to basic science. As an example, we use the response to mass layoffs to discriminate betwe...

Political pronouncements and policy statements include much conjecture concerning the health and behavioral effects of economic decline. We both summarize empirical research concerned with those effects and suggest questions for future research priorities. We separate the studies into groups defined by questions asked, mechanisms invoked, and outco...