Dataset Information

Economic Downturns and Inequities in Birth Outcomes: Evidence From 149 Million US Births.

ABSTRACT: Using birth certificate data for nearly all registered US births from 1976 to 2016 and monthly data on state unemployment rates, we reexamined the link between macroeconomic variation and birth outcomes. We hypothesized that economic downturns reduce exposure to work-related stressors and pollution while increasing exposure to socioeconomic stressors like job loss. Because of preexisting inequalities in health and other resources, we expected that less-educated mothers and black mothers would be more exposed to macroeconomic variation. Using fixed-effect regression models, we found that a 1-percentage-point increase in state unemployment during the first trimester of pregnancy increased the probability of preterm birth by 0.1 percentage points, while increases in the state unemployment rate during the second/third trimester reduced the probability of preterm birth by 0.06 percentage points. During the period encompassing the Great Recession, the magnitude of these associations doubled in size. We found substantial variation in the impact of economic conditions across different groups, with highly educated white women least affected and less-educated black women most affected. The results highlight the increased relevance of economic conditions for birth outcomes and population health as well as continuing, large inequities in the exposure and impact of macroeconomic fluctuations on birth outcomes.

SUBMITTER: Noelke C

PROVIDER: S-EPMC7476222 | biostudies-literature | 2019 Jun

REPOSITORIES: biostudies-literature

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Economic Downturns and Inequities in Birth Outcomes: Evidence From 149 Million US Births.

Noelke Clemens C Chen Yu-Han YH Osypuk Theresa L TL Acevedo-Garcia Dolores D

American journal of epidemiology 20190601 6

Using birth certificate data for nearly all registered US births from 1976 to 2016 and monthly data on state unemployment rates, we reexamined the link between macroeconomic variation and birth outcomes. We hypothesized that economic downturns reduce exposure to work-related stressors and pollution while increasing exposure to socioeconomic stressors like job loss. Because of preexisting inequalities in health and other resources, we expected that less-educated mothers and black mothers would be ...[more]

PMID: 30989169

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Project description:OBJECTIVES:The aim of our work was to analyse the effect of maternal smoking on body size and body proportions of newborns when the mother had smoked only during the first trimester, in comparison with continued smoking after the first trimester. Furthermore, we have evaluated how growth restriction associated with maternal smoking contributes to changes in body proportions. DESIGN:Register-based cohort study SETTING: Maternal Exposure (MATEX) cohort identified from the Finnish Medical Birth Register. PARTICIPANTS:Singleton births without congenital anomalies and missing data (1.38?million) from 1 January 1991 to 31 December 2016. METHODS:Logistic regression was used to quantify the effect of maternal smoking, stratified by the maternal smoking status. OUTCOME MEASURES:Body proportions indicated by low brain-to-body ratio (defined as <10th percentile); high ponderal index and high head-to-length ratio (defined as >90th percentile); small body size for gestational age at birth (defined as weight, length or head circumference <10th percentile) and preterm birth (<37?weeks) and low birth weight (2500?g). RESULTS:Continued smoking after the first trimester was associated with high ponderal index (OR 1.26, 95%?CI 1.23 to 1.28), low brain-to-body ratio (1.11, 1.07-1.15) and high head-to-length ratio (1.22, 1.19-1.26), corresponding with absolute risks of 22%, 10% and 19%, respectively). The effects were slightly lower when smoking had been quit during the first trimester. Similar effects were seen for the body size variables and low birth weight. Preterm birth was not associated with smoking only during first trimester. CONCLUSIONS:Maternal smoking, independent of smoking duration during pregnancy, was associated with abnormal body proportions resulting from larger reduction of length and head circumference in comparison to weight. The effects of having quit smoking during the first trimester and having continued smoking after the first trimester were similar, suggesting the importance of early pregnancy as a sensitive exposure window.

Dataset Information

Economic Downturns and Inequities in Birth Outcomes: Evidence From 149 Million US Births.

Publications

Economic Downturns and Inequities in Birth Outcomes: Evidence From 149 Million US Births.

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