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摘要
Several studies have demonstrated that neighborhood poverty increases the risk for preterm birth among both African American and white women. Some investigators have hypothesized that upward economic mobility of African American women from early life residence in impoverished neighborhoods to residence as adults in affluent neighborhoods is associated with a lower risk of preterm birth. It is well established that low birthweight (LBW) is a risk factor for preterm birth in both races and may be the major marker for aberrant fetal programming. Few studies have investigated the effect of upward economic mobility among African American women born with LBW or non-LBW with early life exposure to neighborhood poverty and affluence as adults on preterm birth or LBW rates of their infants.
This population-based cohort study investigated the effect of upward economic mobility during adulthood among former LBW and non-LBW African American women who had been raised in impoverished neighborhoods on preterm birth rates of their children. Data were obtained for data sets of African American infants (born between 1989 and 1991) in Chicago and their mothers (n = 11,265; born between 1956 and 1976); these data were linked with information on neighborhood-level income appended from the US Census to estimate possible changes in economic environment during early life and adulthood. Multilevel logistic regression analyses models were used to adjust for individual-level risk factors within residential neighborhood groupings.
The preterm birth rate among African American mothers with a lifelong residence in impoverished neighborhoods was 18.7%. Compared to African American mothers with lifelong impoverishment, African American mothers experiencing low, moderate, or high upward economic mobility by adulthood had lower preterm birth rates of 16.0%, 15.2%, and 12.4%, respectively; the crude rate ratios were 0.9 (95% confidence interval [ CI], 0.8-0.9), 0.8 (95% CI, 0.7-0.9), and 0.7 (95% CI, 0.6-0.8). The adjusted data showed that increased risk of preterm birth for infants of 20- to 35-year-old mothers who experienced high upward mobility occurred in mothers who had non-LBW (adjusted odds ratio, 0.7; 95% CI, 0.5-1.7, P < 0.05) but not among mothers who were born with LBW (adjusted odds ratio, 0.7; 95% CI, 0.5-0.9, P = NS).
These findings show that upward economic mobility of African American women from early life to adulthood is associated with a decreased risk of preterm birth.
However, consistent with the fetal programming theory of reproductive outcome, rates of preterm birth are not improved among such mothers born with LBW.
- 出版日期2011-6
- 单位西北大学
