Associations Between Long- and Short-Term Exposure to Neighborhood Social Context and Pregnancy-Related Weight Gain

Background: Weight gained during childbearing has significant implications for maternal and child health. Both too much and too little weight gained during pregnancy can result in adverse outcomes. Recommendations for ideal gestational weight gain (GWG) have been developed by the Institute of Medicine, but achieving these standards remains a challenge. Better understanding of the wider context in which women experience pregnancy may aid in the development of novel interventions to improve trends in healthy GWG. Neighborhoods define one such dimension of women’s wider context that is emerging as a promising factor in this area of research. However, limited work has considered long-term exposure to neighborhood environments or the role of women’s perceptions of their neighborhood environments in relation to either inadequate or excessive GWG./nMethods: This dissertation explores the associations between long- and short-term exposure to neighborhood social and socioeconomic context and GWG using data from the 1979 National Longitudinal Survey of Youth. It additionally investigates associations between objective and perceived measures of neighborhood social context in relation to GWG. The first paper investigates associations between long-term, cumulative neighborhood socioeconomic deprivation and GWG. The second paper investigates associations between objectively measured and perceptions of point-in-time neighborhood social environment and GWG. Objective neighborhood social environment is measured using neighborhood socioeconomic deprivation. Perceived neighborhood social environment is assessed from women’s self-report of problems within their neighborhood environment. The final paper in this dissertation conducts a systematic review of the literature to characterize the reporting error associated with use of self-reported, pregnancy-related weight in efforts to move the field toward developing bias correction techniques to address methodological limitations of this measure. While not directly related to understanding neighborhoods and GWG, this issue is relevant to future studies in this area that rely on self-reported weight./nConclusion: The papers included in this dissertation illustrate the importance of considering both long-term and short-term measures of neighborhood social context in order to fully understand how neighborhood environments impact inadequate and excessive GWG. In particular, long-term measures of exposure to neighborhood environments should be more fully considered in order to better understand how neighborhoods can support healthy GWG. Interventions based on this improved knowledge of the environment in which women experience weight gain during pregnancy may improve GWG outcomes and health trajectories of both mother and child. Future studies in this area may also benefit from more rigorous study of variation of reporting error in self-reported pregnancy-related weight by maternal characteristics, which will aid in the development of bias correction techniques for these widely used measures.

Advisor: Mujahid, Mahasin