The role of neighborhood deprivation in the cervicovaginal microbiota

Abstract

BackgroundLactobacillus-deficient cervicovaginal microbiota is associated with spontaneous preterm birth and is more common among Black individuals. Persistent racial segregation in the United States has led to differential neighborhood exposures by race that can affect pregnancy outcomes. The extent to which neighborhood exposures may explain racial differences in the cervicovaginal microbiota is unknown. ObjectiveWe sought to determine if neighborhood deprivation, defined as material community deprivation, is associated with a Lactobacillus-deficient cervicovaginal microbiota in a prospective cohort of pregnant individuals. Our hypothesis is that racial differences in neighborhood deprivation may explain the higher prevalence of Lactobacillus-deficient cervicovaginal microbiota in Black birthing people. Design/MethodsWe analyzed data from Motherhood & Microbiome, a prospective pregnancy cohort enrolled from prenatal clinics in a single hospital system 2013-2016 in which a Lactobacillus-deficient cervicovaginal microbiota was previously shown to be associated with spontaneous preterm birth. We geocoded addresses to obtain census tract neighborhood deprivation data from the Brokamp Nationwide Community Deprivation Index that uses weighted proportions of poverty, income, public assistance, lack of health insurance, and vacant housing. Generalized linear mixed models quantified associations of deprivation with the cervicovaginal microbiota accounting for geographical clustering by census tract and potential confounders. Due to different distributions of neighborhood deprivation and the cervicovaginal microbiota, we performed race-stratified models. Mediation analyses quantified the extent to which deprivation may contribute to racial differences in the cervicovaginal microbiota. ResultsHigher neighborhood deprivation was associated with a Lactobacillus-deficient cervicovaginal microbiota. Per standard deviation increment of deprivation, participants had 28% higher adjusted odds (aOR 1.28, 95% CI: 1.04-1.58) of a Lactobacillus-deficient microbiota. Black participants had higher odds of a Lactobacillus-deficient microbiota than White participants (aOR 4.00, 95% CI: 2.05, 8.26), and mediation analysis revealed that deprivation accounted for 22% (P=0.046) of that disparity. ConclusionNeighborhood deprivation was associated a Lactobacillus-deficient cervicovaginal microbiota and may partially explain Black-White disparities in the cervicovaginal microbiota. Mechanistic studies to explore how environmental exposures modify the cervicovaginal microbiota are warranted to identify novel opportunities for future interventional strategies to prevent preterm birth. As these findings demonstrate a potential biologic impact from neighborhood conditions, policies that drive urban planning should be explored to improve pregnancy outcomes.