Associations between neighborhood violence during pregnancy and birth outcomes: evidence from S\xe3o Paulo\u2019s Western Region Birth Cohort

Angélica Carreira Dos Santos,Alexandra Brentani,Günther Fink

doi:10.1186/s12889-021-10900-y

Angélica Carreira Dos Santos, Alexandra Brentani + Show 1 more

Open Access

https://doi.org/10.1186/s12889-021-10900-y

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Abstract

BackgroundLow birth weight and prematurity remain leading causes of infant mortality and morbidity globally. Although extensive literature has highlighted the importance of socioenvironmental characteristics for birth outcomes, the role of indirect violence on health remains fairly understudied.MethodsUsing geocoded birth records from the ongoing Western Region Birth Cohort (Região Oeste Coorte – ROC-Cohort) of infants born between 2012 and 2014 and geocoded crime reports, we assessed the associations between exposure to violent crimes during pregnancy within a 1-km radius of the mother’s residence and low birth weight, preterm delivery, and being born small-for-gestational-age. Violent crime exposure was categorized into quintiles. Multivariate logistic regressions were used to examine the associations between violence exposure and birth outcomes. Models were adjusted for sex, maternal age and education, socioeconomic status, and risk factors such as hypertension, diabetes, smoking, and drinking during pregnancy.ResultsAmong the 5268 children included, the average crime exposure during the first two trimesters of pregnancy ranged from 0.44 violent crimes in the least exposed quintile to 12.74 crimes in the most exposed. Compared to children with the lowest violence exposure, children in the highest exposure quintile had higher odds of being born small-for-gestational-age (1.41[1.06–1.89]), preterm (1.35[1.01–1.80]), and low birth weight (1.42[1.03–1.98]). While socioeconomic status and maternal education were positively associated with lower violence exposure, no associations were found between these characteristics and birth outcomes.ConclusionsHigher exposure to violent crimes in the close vicinity of pregnant women’s residence is associated with substantial increases in the odds of adverse birth outcomes. Policies to improve neighborhood safety can potentially contribute not only to the short-term wellbeing of populations but may also have large social, economic, and health benefits in the long term.

Highlights

Low birth weight and prematurity remain leading causes of infant mortality and morbidity globally
Outcomes The analysis focused on three adverse birth outcomes: low birth weight (LBW), preterm delivery (PT), and small-for-gestational-age (SGA)
Following most of the external violence literature, we focused on violent crime in our analysis, which includes willful murder, robbery followed by death, bodily injury followed by death and death resulting from police intervention but excludes other crimes such as robberies without injuries

Summary

Introduction

Low birth weight and prematurity remain leading causes of infant mortality and morbidity globally. Low birth weight accounts for more than 80% of all neonatal mortality globally [1]. Neonates born with low birth weight – about two-thirds of which are preterm [1] - face higher morbidity risks, increased risk of stunting, increased risk of long-term development impairment, as well as increased vulnerability to chronic disease [1,2,3,4,5,6,7]. An estimated homicide rate of 28.5 implies that Latin America’s crime rates are approximately 8 times higher than those seen in HICs on average and 14 times those seen in low-middle-income countries (LMICs) in the Western Pacific Region [11]

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