Project 1: The Environmental Riskscape, Disasters and Obstetric Outcomes

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Despite advances in health care, African-Americans (AA) continue to experience a disproportionate burden of poor obstetric outcomes. This is alarming as pregnancy is a window of future health and many obstetric outcomes, such as preterm birth, are associated with severe morbidity and mortality for both the mother and her infant and result in high societal and economic costs. Unfortunately, the origin of racial disparities in obstetric outcomes does not appear to be genetic nor fully explained by individual-level factors; thus, we must look toward the broader context in the physical, built, and social environments to mitigate racial disparities in maternal health. Because communities of color and low socioeconomic status experience a higher burden of chemical exposures, in part due to the proximity of their neighborhoods to key exposure sources (e.g., industry and hazardous waste sites), ‘environment’ has been hypothesized to be a driver of racial disparities in obstetric outcomes. Two classes of pollutants with historic contamination in Houston, TX are polycyclic aromatic hydrocarbons (PAHs) and metals, which have each been positively associated with preterm birth. Additionally, under an environmental riskscape framework, place-based stressors may also contribute to racial disparities in maternal health by directly influencing disease risk and by modifying women’s susceptibility to chemical exposures. Enhanced understanding of the role of the riskscape, and mixtures of chemical and non-chemical stressors, in racial disparities in obstetric outcomes would promote efforts to design successful interventions and improve the wellbeing of health disparity populations. Finally, Houston is a disaster-prone area, which may result in increased exposures to chemical, biological and non-chemical stressors that may be heightened among health disparity populations. Our goal is to mitigate maternal and infant health disparities in an overburdened population living in a disaster-prone region. To achieve this goal, the Objective of this Research Project, The Environmental Riskscape, Disasters and Obstetric Outcomes, is to utilize a large-scale perinatal biobank and data repository (PeriBank) at Baylor College of Medicine to characterize racial disparities in the riskscape of AA and non- Hispanic white (NHW) pregnant women in Houston, to assess associations between the mixture of chemical and non-chemical stressors in the riskscape on preterm birth, and explore the impact of a natural disaster of unprecedented magnitude (Hurricane Harvey) on racial disparities in chemical exposures. Through the application of a riskscape-based approach paired with statistical methods to address mixture effects, the results from this study will enhance our understanding of the roles of chemical and non-chemical stressors in racial disparities in preterm birth in a disaster-prone region. This work will lay the foundation for future studies to improve our understanding of drivers of black-white disparities in obstetric outcomes, research that is imperative for the development and successful implementation of preventive interventions to mitigate these disparities.