Racial Disparities in Neighborhood and Household Socioeconomic Disadvantage Predict Postpartum Weight Retention.
Racial Disparities in Neighborhood and Household Socioeconomic Disadvantage Predict Postpartum Weight Retention.
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DOI：
10.1016/j.focus.2022.100029
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发表时间：
2022-12
期刊：
影响因子：
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通讯作者：
Leerkes, Esther M
中科院分区：
文献类型：
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作者：
Avorgbedor, Forgive;McCoy, Thomas P;Wideman, Laurie;Shriver, Lenka H;Buehler, Cheryl;Leerkes, Esther M
社区的社会经济劣势预示着家庭的劣势会更高。黑人妇女的邻里和家庭资源受到限制。由于家庭不利而造成的邻里关系与产后体重保持率较高有关。相对于所有其他女性，黑人女性由于劣势而具有更高的产后体重保留率。结构性种族主义导致社区层面的社会经济劣势，从而决定了不良的出生结果。个人社会经济劣势与健康妊娠结局受损有关。本研究旨在调查种族、社区社会经济劣势和家庭社会经济劣势预测随后母亲产后体重保持的途径。共有 176 名 (N=176) 名不同种族的女性从妊娠晚期到产后 6 个月进行了研究。社区社会经济劣势是根据美国社区调查的信息来定义的，该调查基于妇女人口普查区以及社区健康食品供应、安全、暴力和步行环境的自我报告。家庭社会经济劣势包括粮食不安全、收入与需求之比和孕产妇教育。妊娠健康风险采用总结性指数进行操作，其中包括孕前超重/肥胖、妊娠期体重过度增加以及妊娠期间诊断出的高血压疾病。产后体重保持率计算为产后 6 个月体重减去孕前体重。使用结构方程模型和引导 CI 来分析数据，以估计间接影响。三分之一的参与者保留了超过 22 磅的体重。产后 6 个月妊娠体重增加。家庭社会经济劣势（β=0.64，p=0.039）和妊娠健康风险（β=0.34，p=0.002）的增加与较高的产后体重保留直接相关。母亲种族/民族通过邻里社会经济劣势和家庭社会经济劣势对产后体重保留产生间接影响。非西班牙裔黑人女性比非西班牙裔白人女性（白人与黑人 β= -0.62；p<0.001）和所有其他女性（其他与黑人 β= -0.22；p=0.013）具有更大的社区社会经济劣势。此外，黑人女性比白人女性有更大的家庭社会经济劣势（白人与黑人 β= -0.35；p=0.004），这两者反过来又预示着更高的产后体重保留。为了防止产后体重滞留，改变减肥行为的教育至关重要，但必须在社区和家庭层面上在基本资源的背景下进行。
Neighborhood socioeconomic disadvantage predicted higher household disadvantage. Neighborhood and household-level resources were constrained among Black women. Neighborhood through household disadvantage was associated with higher postpartum weight retention. Black women had higher postpartum weight retention relative to all other women via disadvantage. Structural racism leads to neighborhood-level socioeconomic disadvantage, which determines adverse birth outcomes. Individual socioeconomic disadvantage is associated with compromised healthy pregnancy outcomes. This study aimed to investigate the pathways by which race, neighborhood socioeconomic disadvantage, and household socioeconomic disadvantage predict subsequent maternal postpartum weight retention. A total of 176 (N=176) racially diverse women were studied from the third trimester to 6 months after delivery. Neighborhood socioeconomic disadvantage was defined by information from the American Community Survey based on women's census tract and self-reports of neighborhood healthy food availability, safety, violence, and walking environment. Household socioeconomic disadvantage included food insecurity, income-to-needs ratio, and maternal education. Pregnancy health risk was operationalized using a summative index that included prepregnancy overweight/obesity, excessive gestational weight gain, and diagnosed hypertensive disorders during pregnancy. Postpartum weight retention was operationalized as a 6-month postpartum weight minus prepregnancy weight. Data were analyzed using structural equation modeling with bootstrapped CIs to estimate indirect effects. One third of participants retained more than 22 lbs. of pregnancy weight gain 6 months after delivery. Increased household socioeconomic disadvantage (β=0.64, p=0.039) and pregnancy health risk (β=0.34, p=0.002) were directly associated with higher postpartum weight retention. Maternal race/ethnicity had an indirect impact on postpartum weight retention through neighborhood socioeconomic disadvantage and household socioeconomic disadvantage. Non-Hispanic Black women had greater neighborhood socioeconomic disadvantage than non-Hispanic White women (White vs Black β= −0.62; p<0.001) and all other women (other vs Black β= −0.22; p=0.013). In addition, Black women had greater household socioeconomic disadvantage than White women (White vs Black β= −0.35; p=0.004), both of which in turn predicted higher postpartum weight retention. To prevent postpartum weight retention, education on behavior change to lose weight is essential, but it must be offered in the context of basic resources, at both the neighborhood and household levels.