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The role of environmental quality in gestational weight gain among U.S. pregnant women
Citation:
Gray, C., L. Messer, S. Grabich, K. Rappazzo, J. Jagai, Y. Jian, AND D. Lobdell. The role of environmental quality in gestational weight gain among U.S. pregnant women. Epidemiology Congress of the Americas 2016, Miami, FL, June 21 - 24, 2016.
Impact/Purpose:
The purpose of this study was to explore overall environmental quality in relation to gestational weight gain among U.S. pregnant women. This study utilized the EPA created Environmental Quality Index.
Description:
From 2000-2009, 44% of United States (US) pregnant women had gestational weight gain (GWG) above and 20% had GWG below the recommended range of 15 to 40 pounds, which depends on starting weight. GWG outside the recommended range is associated with adverse outcomes including pre-eclampsia, gestational diabetes, and preterm birth. In the US, the burden of excessive gain is of particular concern, partly due to racial disparities associated with obesity. Some studies have associated neighborhood factors with GWG, though environmental studies and studies of racial heterogeneity of effects have been limited. We sought to examine the association between cumulative environmental quality and GWG, and to explore modification by maternal race/ethnicity categories of white non-Hispanic (WNH), black non-Hispanic (BNH) and Hispanic in stratified analyses. We used the county-level Environmental Quality Index (EQI; range: 9 standard normal units; higher is worse quality), which incorporates variables from five environmental domains (air, water, land, built and sociodemographic), to estimate associations between the EQI and GWG in geocoded U.S birth records from the National Center for Health Statistics from 2000-2005 (n=19,795,782 births). We estimated pounds of GWG per unit increase in the EQI and 95% confidence intervals (CI) using fixed slope, random intercept linear regression models, clustered by county, and adjusted for marital status, and maternal race, education and age. Worsening environmental quality was associated with increased GWG (coefficient: 0.49; 95% CI: 0.48, 0.50). The association between worsening environmental quality and increased GWG was strongest for BNH (coefficient: 0.84; 95% CI: 0.82, 0.86), followed by WNH (coefficient: 0.50; 95% CI: 0.49, 0.51), and Hispanic (coefficient: 0.36; 95% CI: 0.34, 0.38). Poor environmental quality is associated with increased GWG, and effects vary by race/ethnicity. This abstract does not reflect EPA policy.