Download PDF
Am J Perinatol 2024; 41(S 01): e2326-e2335
DOI: 10.1055/s-0043-1771256
Original Article

Examining the Relationship between Social Determinants of Health and Adverse Pregnancy Outcomes in Black Women

Shannon L. Walker
1   Institute for Health and Equity (IHE), Medical College of Wisconsin, Milwaukee, Wisconsin
2   Center for Advancing Population Science (CAPS), Medical College of Wisconsin, Milwaukee, Wisconsin
,
Rebekah J. Walker
2   Center for Advancing Population Science (CAPS), Medical College of Wisconsin, Milwaukee, Wisconsin
3   Division of General Internal Medicine, Department of Medicine, Froedtert and The Medical College of Wisconsin
,
Anna Palatnik 
4   Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Froedtert and The Medical College of Wisconsin
,
Aprill Z. Dawson
2   Center for Advancing Population Science (CAPS), Medical College of Wisconsin, Milwaukee, Wisconsin
3   Division of General Internal Medicine, Department of Medicine, Froedtert and The Medical College of Wisconsin
,
Joni S. Williams
2   Center for Advancing Population Science (CAPS), Medical College of Wisconsin, Milwaukee, Wisconsin
3   Division of General Internal Medicine, Department of Medicine, Froedtert and The Medical College of Wisconsin
,
Leonard E. Egede
2   Center for Advancing Population Science (CAPS), Medical College of Wisconsin, Milwaukee, Wisconsin
3   Division of General Internal Medicine, Department of Medicine, Froedtert and The Medical College of Wisconsin
› Author Affiliations Funding Effort for this study was partially supported by the National Institute of Diabetes and Digestive Kidney Disease (K24DK093699, R01DK118038, R01DK120861, PI: Egede; R21DK123720, PI: Williams), the National Institute for Minority Health and Health Disparities (R01MD013826, PI: Egede/Walker), and the American Diabetes Association (1-19-JDF-075, PI: Walker), U.S. Department of Health and Human Services, National Institutes of Health.
› Further Information
Also available at
    Permissions and Reprints

Abstract

Objective Our objective was to examine associations between social determinants of health (cultural, neighborhood, and psychosocial factors) and adverse pregnancy outcomes (gestational age at birth [GAB], preterm birth [PTB], and preeclampsia) in Black women.

Study Design Cross-sectional data (n = 204) comprised adult Black women aged ≥18 years who delivered between 2013 and 2022 in Milwaukee,Wisconsin. Sequential unadjusted linear and logistic regression models were run to evaluate associations between social determinants of health and pregnancy outcomes. Stepwise regressions with forward selection were run to test the contribution of the social determinants of health to adverse pregnancy outcomes, independent of the contribution of established risk factors.

Results Mean GAB was 37.9 weeks, 19.6% had a PTB and 17.7% had preeclampsia. In all fully adjusted models, education (β0.15, 95% confidence interval [CI]: 0.005, 0.29), nulliparity (β −1.26, 95%CI: −2.08, −0.44), multifetal gestation (β −2.67, 95% CI: −4.29, −1.05), and exposure to neighborhood violence (β −0.13, 95%CI: −0.25, −0.005) were associated with shortened GAB. Education (adjusted odds ratio [aOR]: 0.83, 95%CI: 0.69, 0.99), provider trust (aOR: 0.94, 95%CI: 0.88, 0.99), chance health locus of control (aOR: 0.88, 95%CI: 0.78, 0.99), and anxiety (aOR: 0.81, 95%CI: 0.69, 0.95) were associated with reduced odds of PTB. Powerful others health locus of control (aOR: 1.16, 95%CI: 1.03, 1.32), depression (aOR: 1.17, 95%CI: 1.01, 1.34), nulliparity (aOR: 4.73, 95%CI: 1.79, 12.55), multifetal gestation (aOR: 17.78, 95%CI: 3.49, 90.50), diabetes (aOR: 4.71, 95%CI: 1.17, 19.00), and obstructive sleep apnea (aOR: 44.28, 95%CI: 2.50, 783.12) were associated with increased odds of PTB. Internal health locus of control (aOR: 1.13, 95%CI: 1.01, 1.25), depression (aOR: 1.09, 95%CI: 1.01, 1.17), preeclampsia in a previous pregnancy (aOR: 5.96, 95% CI: 2.22, 16.01), and kidney disease (aOR: 34.27, 95% CI: 1.54, 763.75) were associated with preeclampsia.

Conclusion Provider trust, health locus of control, neighborhood violence, depression, and anxiety were associated with adverse pregnancy outcomes in Black women, independent of demographic and clinical risk factors.

Key Points

  • We identified associations between exposure to neighborhood violence and gestational age at birth.

  • Trust, locus of control, depression, and anxiety were associated with preterm birth and preeclampsia.

  • Future research should focus on interventions that address social and clinical factors.

Keywords

social determinants of health - preterm birth - preeclampsia - race/ethnicity - health disparities


Publication History

Received: 18 February 2023

Accepted: 15 June 2023

Article published online:
21 July 2023

© 2023. Thieme. All rights reserved.

Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA

 

  • References

  • 1 Osterman M, Hamilton B, Martin JA, Driscoll AK, Valenzuela CP. Births: Final Data for 2020. Natl Vital Stat Rep 2021; 70 (17) 1-50
    PubMedGoogle Scholar
  • 2 Yee LM, Miller EC, Greenland P. Mitigating the long-term health risks of adverse pregnancy outcomes. JAMA 2022; 327 (05) 421-422
    CrossrefPubMedGoogle Scholar
  • 3 Minhas AS, Ying W, Ogunwole SM. et al. The association of adverse pregnancy outcomes and cardiovascular disease: current knowledge and future directions. Curr Treat Options Cardiovasc Med 2020; 22 (12) 61
    CrossrefPubMedGoogle Scholar
  • 4 Kramer MS. The epidemiology of adverse pregnancy outcomes: an overview. J Nutr 2003; 133 (5 suppl 2): 1592S-1596S
    CrossrefPubMedGoogle Scholar
  • 5 Gadson A, Akpovi E, Mehta PK. Exploring the social determinants of racial/ethnic disparities in prenatal care utilization and maternal outcome. Semin Perinatol 2017; 41 (05) 308-317
    CrossrefPubMedGoogle Scholar
  • 6 Xu J. et al. Deaths: Final Data for 2019. Natl Vital Stat Rep 2021; 70 (08) 15-17
    PubMedGoogle Scholar
  • 7 McCormick MC, Litt JS, Smith VC, Zupancic JA. Prematurity: an overview and public health implications. Annu Rev Public Health 2011; 32: 367-379
    CrossrefPubMedGoogle Scholar
  • 8 US Centers for Disease Control and Prevention. Preterm Birth. 2021 Accessed June 28, 2023 at: https://www.cdc.gov/reproductivehealth/maternalinfanthealth/pretermbirth.htm
    PubMedGoogle Scholar
  • 9 March of Dimes. Preeclampsia. 2020 Accessed June 28, 2023 at: https://www.marchofdimes.org/complications/preeclampsia.aspx
    PubMedGoogle Scholar
  • 10 Institute of Medicine Committee on Understanding Premature Birth and Assuring Healthy Communities. . The National Academies Collection: Reports funded by National Institutes of Health, in Preterm Birth: Causes, Consequences, and Prevention, R.E. Behrman and A.S. Butler, Editors. 2007. , National Academies Press (US)
  • 11 Culhane JF, Goldenberg RL. Racial disparities in preterm birth. Semin Perinatol 2011; 35 (04) 234-239
    CrossrefPubMedGoogle Scholar
  • 12 Engelhardt KA, Hisle-Gorman E, Gorman GH, Dobson NR. Lower preterm birth rates but persistent racial disparities in an open-access health care system. Mil Med 2018; 183 (9-10): e570-e575
    CrossrefPubMedGoogle Scholar
  • 13 Hamilton B, Martin J, Osterman M. Births: Provisional data for 2021. 2022
    PubMedGoogle Scholar
  • 14 Fingar KR. et al. Delivery hospitalizations involving preeclampsia and eclampsia, 2005–2014. Agency for Healthcare Research and Quality (US), Rockville (MD); 2006
    Google Scholar
  • 15 Ghosh G, Grewal J, Männistö T. et al. Racial/ethnic differences in pregnancy-related hypertensive disease in nulliparous women. Ethn Dis 2014; 24 (03) 283-289
    PubMedGoogle Scholar
  • 16 Ross KM, Dunkel Schetter C, McLemore MR. et al. Socioeconomic status, preeclampsia risk and gestational length in black and white women. J Racial Ethn Health Disparities 2019; 6 (06) 1182-1191
    CrossrefPubMedGoogle Scholar
  • 17 US Centers for Disease Control and Prevention. Premature Birth. 2021 [cited 2022 October 23]. Accessed June 28, 2023 at: https://www.cdc.gov/reproductivehealth/features/premature-birth/index.html
    PubMedGoogle Scholar
  • 18 ACOG. ACOG Practice Bulletin No. 202: Gestational Hypertension and Preeclampsia. Obstet Gynecol 2019; 133 (01) 1
    PubMedGoogle Scholar
  • 19 ACOG. Gestational Hypertension and Preeclampsia: ACOG Practice Bulletin, Number 222. Obstet Gynecol 2020; 135 (06) e237-e260
    CrossrefPubMedGoogle Scholar
  • 20 Fox R, Kitt J, Leeson P, Aye CYL, Lewandowski AJ. Preeclampsia: risk factors, diagnosis, management, and the cardiovascular impact on the offspring. J Clin Med 2019; 8 (10) 1625
    CrossrefPubMedGoogle Scholar
  • 21 Institute of Medicine Committee on Understanding Premature Birth and Assuring Healthy Communities. 4 Sociodemographic and Community Factors Contributing to Preterm Birth, in Preterm Birth: Causes, Consequences, and Prevention. Washington DC: National Academies Press; 2007
    Google Scholar
  • 22 National Institute of Child Health and Human Development. What are the risk factors for preterm labor and birth?. 2017 Accessed June 28, 2023 at: https://www.nichd.nih.gov/health/topics/preterm/conditioninfo/who_risk
    PubMedGoogle Scholar
  • 23 Manuck TA. Racial and ethnic differences in preterm birth: a complex, multifactorial problem. Semin Perinatol 2017; 41 (08) 511-518
    CrossrefPubMedGoogle Scholar
  • 24 US Office of Disease Prevention and Health Promotion. Social Determinants of Health. n.d. . Accessed June 28, 2023 at: https://health.gov/healthypeople/priority-areas/social-determinants-health
    PubMedGoogle Scholar
  • 25 US Office of Disease Prevention and Health Promotion. Social Determinants of Health. 2022 Accessed June 28, 2023 at: https://www.healthypeople.gov/2020/topics-objectives/topic/social-determinants-of-health?topicid=39
    PubMedGoogle Scholar
  • 26 The World Health Organization. A conceptual framework for action on the social determinants of health. 2007 . Accessed November 2022 at: https://apps.who.int/iris/handle/10665/44489
    PubMedGoogle Scholar
  • 27 Sheppard VB, Zambrana RE, O'Malley AS. Providing health care to low-income women: a matter of trust. Fam Pract 2004; 21 (05) 484-491
    CrossrefPubMedGoogle Scholar
  • 28 Patterson F, Seravalli L, Hanlon A, Nelson DB. Neighborhood safety as a correlate of tobacco use in a sample of urban, pregnant women. Addict Behav 2012; 37 (10) 1132-1137
    CrossrefPubMedGoogle Scholar
  • 29 Yu Y, Zhang S, Wang G. et al. The combined association of psychosocial stress and chronic hypertension with preeclampsia. Am J Obstet Gynecol 2013; 209 (05) 438.e1-438.e12
    CrossrefPubMedGoogle Scholar
  • 30 Dole N, Savitz DA, Siega-Riz AM, Hertz-Picciotto I, McMahon MJ, Buekens P. Psychosocial factors and preterm birth among African American and White women in central North Carolina. Am J Public Health 2004; 94 (08) 1358-1365
    CrossrefPubMedGoogle Scholar
  • 31 American Heart Association. Understanding Blood Pressure Readings. 2022 Accessed June 28, 2023 at: https://www.heart.org/en/health-topics/high-blood-pressure/understanding-blood-pressure-readings
    PubMedGoogle Scholar
  • 32 Gynecologists ACO. Hypertension in pregnancy. Report of the American College of Obstetricians and Gynecologists' Task Force on Hypertension in Pregnancy. Obstet Gynecol 2013; 122 (05) 1122-1131
    CrossrefPubMedGoogle Scholar
  • 33 Egede LE, Ellis C. Development and testing of the multidimensional trust in health care systems scale. J Gen Intern Med 2008; 23 (06) 808-815
    CrossrefPubMedGoogle Scholar
  • 34 Stanton AL, Kirk SB, Cameron CL, Danoff-Burg S. Coping through emotional approach: scale construction and validation. J Pers Soc Psychol 2000; 78 (06) 1150-1169
    CrossrefPubMedGoogle Scholar
  • 35 Wagnild GM, Young HM. Development and psychometric evaluation of the Resilience Scale. J Nurs Meas 1993; 1 (02) 165-178
    PubMedGoogle Scholar
  • 36 Wallston KA, Wallston BS, DeVellis R. Development of the Multidimensional Health Locus of Control (MHLC) Scales. Health Educ Monogr 1978; 6 (02) 160-170
    CrossrefPubMedGoogle Scholar
  • 37 Moffet HH, Adler N, Schillinger D. et al. Cohort Profile: The Diabetes Study of Northern California (DISTANCE)—objectives and design of a survey follow-up study of social health disparities in a managed care population. Int J Epidemiol 2009; 38 (01) 38-47
    CrossrefPubMedGoogle Scholar
  • 38 Echeverria SE, Diez-Roux AV, Link BG. Reliability of self-reported neighborhood characteristics. J Urban Health 2004; 81 (04) 682-701
    CrossrefPubMedGoogle Scholar
  • 39 US Centers for Disease Control and Prevention. Behavioral Risk Factor Surveillance System Questionnaire. 2014 Accessed June 28, 2023 at: https://www.cdc.gov/brfss/annual_data/annual_2014.html
    PubMedGoogle Scholar
  • 40 Kroenke K, Spitzer RL, Williams JB. The PHQ-9: validity of a brief depression severity measure. J Gen Intern Med 2001; 16 (09) 606-613
    CrossrefPubMedGoogle Scholar
  • 41 Spitzer RL, Kroenke K, Williams JB, Löwe B. A brief measure for assessing generalized anxiety disorder: the GAD-7. Arch Intern Med 2006; 166 (10) 1092-1097
    CrossrefPubMedGoogle Scholar
  • 42 Cohen S, Kamarck T, Mermelstein R. A global measure of perceived stress. J Health Soc Behav 1983; 24 (04) 385-396
    CrossrefPubMedGoogle Scholar
  • 43 The World Health Organization. International Statistical Classification of Diseases and Related Health Problems (ICD). 2019 Accessed June 28, 2023 at: https://www.who.int/classifications/classification-of-diseases
    PubMedGoogle Scholar
  • 44 White S. Basic and Clinical Biostatistics: 5th ed. New York, NY: McGraw-Hill Education; 2019
    Google Scholar
  • 45 Dos Santos AC, Brentani A, Fink G. Associations between neighborhood violence during pregnancy and birth outcomes: evidence from São Paulo's Western Region Birth Cohort. BMC Public Health 2021; 21 (01) 865
    CrossrefPubMedGoogle Scholar
  • 46 Catov JM, Abatemarco DJ, Markovic N, Roberts JM. Anxiety and optimism associated with gestational age at birth and fetal growth. Matern Child Health J 2010; 14 (05) 758-764
    CrossrefPubMedGoogle Scholar
  • 47 Wheeler S, Maxson P, Truong T, Swamy G. Psychosocial stress and preterm birth: the impact of parity and race. Matern Child Health J 2018; 22 (10) 1430-1435
    CrossrefPubMedGoogle Scholar
  • 48 Mendez DD, Hogan VK, Culhane JF. Institutional racism, neighborhood factors, stress, and preterm birth. Ethn Health 2014; 19 (05) 479-499
    CrossrefPubMedGoogle Scholar
  • 49 Holroyd LE, Anders S, Robinson JR, Jackson GP. Use of the multidimensional health locus of control to predict information-seeking behaviors and health-related needs in pregnant women and caregivers. AMIA Annu Symp Proc 2018; 2017: 902-911
    PubMedGoogle Scholar
  • 50 Ashford KB, Rayens MK. Ethnicity, smoking status, and preterm birth as predictors of maternal locus of control. Clin Nurs Res 2015; 24 (02) 172-187
    CrossrefPubMedGoogle Scholar
  • 51 Kordi M, Heravan MB, Asgharipour N, Akhlaghi F, Mazloum SR. Does maternal and fetal health locus of control predict self-care behaviors among women with gestational diabetes?. J Educ Health Promot 2017; 6: 73
    CrossrefPubMedGoogle Scholar
  • 52 Katz KS, Blake SM, Milligan RA. et al. The design, implementation and acceptability of an integrated intervention to address multiple behavioral and psychosocial risk factors among pregnant African American women. BMC Pregnancy Childbirth 2008; 8 (01) 22
    CrossrefPubMedGoogle Scholar
  • 53 Kiely M, El-Mohandes AAE, El-Khorazaty MN, Gantz MG. An integrated intervention to reduce intimate partner violence in pregnancy: a randomized controlled trial. Obstet Gynecol 2010; 115 (2 Pt 1): 273-283
    CrossrefPubMedGoogle Scholar
  • 54 Subramanian S, Katz KS, Rodan M. et al. An integrated randomized intervention to reduce behavioral and psychosocial risks: pregnancy and neonatal outcomes. Matern Child Health J 2012; 16 (03) 545-554
    CrossrefPubMedGoogle Scholar