Association of maternal education, neighborhood deprivation, and racial segregation with gestational age at birth by maternal race/ethnicity and United States Census region in the ECHO cohorts
Authors: Dunlop Anne L. , Burjak Mohamad , Dean Lorraine T. , Alshawabkeh Akram N. , Avalos Lyndsay A. , Aschner Judy L. , Breton Carrie V. , Charifson Mia A. , Cordero Jose , Dabelea Dana , D’Sa Viren , Duarte Cristiane S. , Elliott Amy J. , Eick Stephanie M. , Ferrara Assiamira , Fichorova Raina N. , Ganiban Jody M. , Gern James E. , Hedderson Monique M. , Herbstman Julie B. , Hipwell Alison E. , Huddleston Kathi C. , Karagas Margaret , Karr Catherine , Kerver Jean M. , Koinis-Mitchell Daphne , Lyall Kristen , Madan Juliette , Marsit Carmen , McEvoy Cindy T. , Meeker John D. , Oken Emily , O’Shea T. Michael , Padula Amy M. , Sathyanarayana Sheela , Schantz Susan , Schmidt Rebecca J. , Snowden Jessica , Stanford Joseph B. , Weiss Scott , Wright Robert O. , Wright Rosalind J. , Zhang Xueying , McGrath Monica 
Published: November 2023

Background

In the United States, disparities in gestational age at birth by maternal race, ethnicity, and geography are theorized to be related, in part, to differences in individual- and neighborhood-level socioeconomic status (SES). Yet, few studies have examined their combined effects or whether associations vary by maternal race and ethnicity and United States Census region.

Methods

We assembled data from 34 cohorts in the Environmental influences on Child Health Outcomes (ECHO) program representing 10,304 participants who delivered a liveborn, singleton infant from 2000 through 2019. We investigated the combined associations of maternal education level, neighborhood deprivation index (NDI), and Index of Concentration at the Extremes for racial residential segregation (ICERace) on gestational weeks at birth using linear regression and on gestational age at birth categories (preterm, early term, post–late term relative to full term) using multinomial logistic regression.

Results

After adjustment for NDI and ICERace, gestational weeks at birth was significantly lower among those with a high school diploma or less (−0.31 weeks, 95% CI: −0.44, −0.18), and some college (−0.30 weeks, 95% CI: −0.42, −0.18) relative to a master’s degree or higher. Those with a high school diploma or less also had an increased odds of preterm (aOR 1.59, 95% CI: 1.20, 2.10) and early term birth (aOR 1.26, 95% CI: 1.05, 1.51). In adjusted models, NDI quartile and ICERace quartile were not associated with gestational weeks at birth. However, higher NDI quartile (most deprived) associated with an increased odds of early term and late term birth, and lower ICERace quartile (least racially privileged) associated with a decreased odds of late or post-term birth. When stratifying by region, gestational weeks at birth was lower among those with a high school education or less and some college only among those living in the Northeast or Midwest. When stratifying by race and ethnicity, gestational weeks at birth was lower among those with a high school education or less only for the non-Hispanic White category.

Conclusion

In this study, maternal education was consistently associated with shorter duration of pregnancy and increased odds of preterm birth, including in models adjusted for NDI and ICERace.