Living in Disadvantaged Neighborhoods Increases the Risk for Having a Very Low Birth Weight Infant among Mothers Exposed to Preconception Stressful Life Events

Background: Previous studies have demonstrated that exposure to preconception stressful life events (PSLEs) increases the risk for having adverse obstetric outcomes; however it is unclear whether neighborhood conditions influence this relationship. This study determined whether the effect of PSLEs on birth weight is stronger among women living in disadvantaged neighborhoods.

Methods: Data were from the Early Childhood Longitudinal Study, Birth Cohort (N=9,300). PSLEs included: death of parents, child or spouse, divorce or separation from partner, and fertility problems prior to conception. Factor analysis was used to create a neighborhood disadvantage index (NDI) using county-level data from the 2000 Census. The NDI was stratified into tertiles representing advantaged, middle advantaged, and disadvantaged neighborhoods. Multinomial logistic regressions stratified by NDI tertile estimated the odds of having very low (VLBW; less than 1,500 grams) or low (LBW; 1,500 to 2,499 grams) birth weight infants, controlling for confounders.

Principal Findings: Adjusted stratified analyses revealed a gradient in the associations between PSLEs and having a VLBW infant by NDI tertile; the association was strongest in disadvantaged neighborhoods (AOR=1.42, CI=1.10-1.85) followed by middle (AOR=1.35; CI=0.92-1.99) and advantaged (AOR=1.08; CI=0.59-1.96) neighborhoods. Neither PSLEs nor neighborhood conditions were associated with the increased odds of having LBW or HBW infants.

Conclusions:  Having a PSLE increased the risk of having VLBW infants among women living in disadvantaged neighborhoods.  To improve birth outcomes, population-level interventions should focus on not only reducing the deleterious effects of stressors, but also improving the health, financial, and educational well-being of neighborhoods.