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
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.
Available from: Jihong Liu
- "Racial disparities in adverse birth outcomes are well documented but not well explained  . Racial disparities vary across geographic regions with different political, economic, and social contexts  , which suggests that studies focusing on environmental factors, including of the neighborhood environment , are needed to explain racial disparities in birth outcomes . "
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Evidence of the association between food environment and birth outcomes is limited. This study aimed to examine the association between individual-level food access measures and birth outcomes.
All birth certificates (N = 15,786) from January 1, 2008 to December 31, 2009 in eight counties in South Carolina were included. Access to food was evaluated by the distance to the nearest food store and the number of each type of store within a 1-mile (1.6-km) radius from the women's homes. Birth outcomes included birth weight, low birth weight, gestational age, and preterm birth (PTB).
A further distance to the nearest convenience store was associated with higher birth weight and gestational age. Birth weight in areas with two or more convenience stores within a 1-mile (1.6-km) buffer was less [two stores: β = -46.2, 95 % confidence interval (CI) -76.5, -15.9; three or more stores: β = -48.6, 95 % CI -78.8, -18.5], and gestational age was shorter in areas with one or two convenience stores (one store: β = -0.11, 95 % CI -0.21, -0.00; two or more stores: β = -0.13, 95 % CI -0.25, 0.00) than in areas without convenience stores in the neighborhood. Having three or more convenience stores in the neighborhood was associated with increased risk of PTB compared with no convenience stores. Accessibility and availability of supermarkets and grocery stores were not associated with any birth outcomes.
Conclusions for practice:
This analysis suggests that access to unhealthy foods is associated with adverse birth outcomes. Future investigations with more comprehensive measures of food environment are warranted.
Available from: link.springer.com
- "Researchers are often interested in how neighborhood characteristics, such as socioeconomic status (SES), impact perinatal health1234. Geocoded birth certificate data are therefore used to examine the effects of neighborhood environments on maternal and infant health around the time of delivery. "
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ABSTRACT: 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-partum period, whether they move to neighborhoods of different socioeconomic status (SES), and whether mobility differs by maternal characteristics.
We used data from the 2003-2007 California Maternal and Infant Health Assessment (MIHA), an annual, statewide-representative survey of post-partum women, to examine women's neighborhood mobility patterns between giving birth and completing a survey 2-7 months post-partum. We examined whether women changed neighborhoods, whether moves were to neighborhoods of higher, lower, or similar socioeconomic status (SES), and whether these patterns differed by maternal race/ethnicity, maternal SES, or other demographic characteristics.
Overall, 93 % of women either did not move neighborhoods or moved to a neighborhood of similar SES post-partum. Only 4 % of women moved to a neighborhood of lower SES and 3 % to an area of higher SES. Mothers who were non-Hispanic black or US-born Hispanic, young, unmarried, primiparous, or lower SES were slightly more likely to move overall and more likely to move to neighborhoods with different SES, compared to other women.
These findings suggest that geocoded addresses from birth certificates can be used to estimate women's neighborhood SES during the early post-partum period with little misclassification, an especially relevant finding for researchers using post-partum surveys.
Available from: Anders Erickson
- "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       . 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.
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