Association of perceived neighborhood safety with maternal and neonatal health: Findings from 2016-2019 PRAMS data

Abstract

Neighborhood crime is a social determinant that has been associated with adverse pregnancy outcomes such as low birthweight (LBW) and preterm birth, but little data address the related construct of perceived neighborhood safety (PNS). Our aims were (1) to characterize pregnant individuals by PNS and (2) to examine the associations of PNS with maternal and neonatal outcomes. This cross-sectional population-based analysis included pregnant individuals with live, singleton births who participated in the Centers for Disease Control Pregnancy Risk Assessment Monitoring System (PRAMS) Phase 8 (2016-2019) from eight states. PNS was determined via survey and analyzed in four categories (Figure). Outcomes of interest included LBW, perinatal depression, attending a postpartum visit, attending more than eight prenatal care visits, and any breastfeeding for eight weeks or greater. Multivariable logistic and Poisson regression were used to ascertain adjusted odd ratio and incidence rate ratios with 95% confidence intervals, controlling for prespecified sociodemographic and clinical characteristics. Of 29,987 individuals eligible for inclusion, the majority (62.8%) were non-Hispanic White, married (60.1%), and had at least 12 years of education (88.7%). Approximately half (56.9%) were privately insured. In this cohort, 78% reported they never felt unsafe, whereas 3% reported they always/often felt unsafe in their neighborhood (Figure). Characteristics associated with always/often feeling unsafe included non-Hispanic Black and Hispanic race and ethnicity, public insurance, and pre-pregnancy smoking (Figure). Individuals who always/often felt unsafe had a greater adjusted odds of LBW infant (aIRR 1.35, 95% CI 1.08-1.69) and perinatal depression (aOR 1.96, 95% CI 1.56-2.47), and lower odds of attending more than eight prenatal care visits (aIRR 0.90, 95% CI 0.85-0.95), compared to those who never felt unsafe. PNS appears to be an independent social determinant of perinatal health, even after accounting for other maternal sociodemographic and clinical characteristics.View Large Image Figure ViewerDownload Hi-res image Download (PPT)