Neighbourhood Socioeconomic Disparity in Exposure to Preterm Birth Risk During the Pandemic: Secondary Analysis of Pregnancy During the Pandemic Cohort
Date
2023-09-17
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Abstract
Background: Preterm birth (PTB) is defined as a live birth before 37 weeks of gestation and remains a major public health concern, affecting an estimated 15 million births annually with a global prevalence of 11%. Socioeconomic disparities play a crucial role in PTB rates, with both individual- and neighborhood-level factors contributing. Stress response pathway has been identified as a key mechanism in the relationship between neighborhood socioeconomic status (nSES) and PTB risk. As such, the new challenges added due to the COVID-19 pandemic, such as disruption to the support networks and increased psychosocial distress for pregnant individuals, were expected to increase PTB rates. However, studies found lack of change or even decrease in the incidence during this period. It is suggested that such counter intuitive findings are due to lack of consideration for the differential exposure to the pandemic-related hardships based on nSES. Therefore, the primary aim of the present study is to test whether a measure of objective pandemic hardship and psychological distress mediate the relationship between nSES and PTB. Methods: Present study is a secondary analysis of the data collected from a prospective longitudinal cohort study, Pregnancy during the Pandemic (PdP). Two serial mediation path models with a measure of baseline objective pandemic hardship and psychological distress included as mediators between nSES and PTB/gestational age (GA) were tested. Results: In both models, the main indirect pathway of interest from nSES to pandemic objective hardship, psychological distress, then PTB/GA was non-significant with minimal effect. Secondary indirect pathway of interest from pandemic objective hardship to psychological distress then PTB/GA was significant in both models while controlling for months into the pandemic at birth and baseline sociodemographic characteristics. Discussion: The present paper is the first to test a comprehensive model of the role of nSES on PTB risk with an explicit measure of pandemic objective hardship and psychological distress included as mediators. While the main indirect serial mediation pathway was non-significant, partial support for the proposed mechanism was observed where increase in pandemic-related hardship elevated psychological distress, which then heightened the risk of PTB risk and shortened gestational age at birth.
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Keywords
Neighbourhood, Socioeconomic Disparity, Pregnancy, Preterm Birth, Pandemic, COVID-19
Citation
Jung, W. K. (2023). Neighbourhood socioeconomic disparity in exposure to preterm birth risk during the pandemic: secondary analysis of pregnancy during the pandemic cohort (Master's thesis, University of Calgary, Calgary, Canada). Retrieved from https://prism.ucalgary.ca.