Transgenerational risk for low birth weight and preterm birth: The role of biology and neighborhood factors in racial disparities

The purpose of this dissertation research is to ascertain the impact of biological factors as well as social and economic environmental factors on the risk of low birth weight (LBW) and preterm birth (PTB) among infants of non-Hispanic (NH) white and NH black mothers, under the hypothesis that intergenerational factors could be explanatory variables in the perpetuated trend in racial/ethnic disparities in birth outcomes. Three separate research studies were performed. The first is a systematic review and meta-analysis of studies reporting the association between LBW/PTB and neighborhood disadvantage, where the results demonstrate that there is a statistically significant higher odds of LBW and PTB among mothers resident in the most disadvantaged neighborhoods relative to those in the least disadvantaged neighborhoods. This relationship was found only when race-stratified, rather than race-adjusted, models were performed. The second and third studies use a transgenerational dataset of births in Allegheny County, Pennsylvania with birth records of infants born in the years 2009-2011 to mothers who were also born in the County in the years 1979-1998. The second study focuses on the role of mothers’ birth weight (MBW) along with social and economic contextual factors on infant risk of LBW; while the third study focuses on the role of mothers’ gestational age (MGA) coupled with social and economic contextual factors on infant risk of PTB. This research makes significant unique contributions to this field of public health research by examining both biological and neighborhood context factors as predictors of PTB and LBW in multivariate and multilevel models. Even more important is the novel examination of the subcategories of birth weight and gestational age, which led to results suggesting differing roles of biology and neighborhood context among these subcategories. LBW and PTB are of public health significance because they increase an infant’s risk of death in the first year of life, developmental disabilities, and chronic diseases in adulthood. The healthcare costs related to treatment of a prematurely born infant costs the United States billions of dollars a year and can be associated with billions more decades later when chronic diseases develop in adulthood