Reproductive Trajectory, Neighborhood Dynamics and Preterm Birth

Associate Name: Li Liu

Funding Source/Period of the Grant: HPC Pilot 02/01/2017 - 02/08/2018


Preterm birth (PTB) is a major yet complex public health issue. Despite mounting evidence on social and biomedical risk factors of PTB, women’s reproductive histories and broader social origins are largely understudied. Institute of Medicine called for studies on social and biomedical risk factors simultaneously. Indeed, biomedical risk factors of PTB may accumulate longitudinally through the life course of women’s reproductive career while social risk factors of PTB may cluster spatially in women’s residential neighborhoods. These multilevel trajectories introduce further complexity. In this Hopkins Population Center (HPC) pilot grant, we seek to study the effects of reproductive trajectories (RT) under various neighborhood conditions on the risk of PTB applying advanced longitudinal modeling to the life course framework. We will leverage extensive biomedical and street address data collected through the Boston Birth Cohort study and expansive neighborhood data from multiple sources. We have two specific aims. First, we examine the effects of RT on the risk of PTB in the first live birth. We will construct RT from the age at menarche to the first live birth. We will apply suitable analytical approaches e.g. Cox proportional hazards models in a life course framework. Second, we examine the joint effects of RT and neighborhood dynamics (ND) on the risk of PTB by mapping out neighborhood characteristics and instability histories that align with RT and applying marginal structural modeling. We will add spatial analysis to the longitudinal models to enhance our ability to make causal inferences of the primary causes and critical periods of RT and ND on PTB. We plan to deliver one peer-reviewed publication upon completion of the grant, and extend in the future to a generalized model for the effects of RT and ND on PTB suitable for high-order live births in a larger project of this pilot.


Photo: "newborns cared for inside an incubator at NICU, in the middle of being attended by nurses" by UNICEF Ethiopia is licensed under CC BY 2.0.