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    • However prior studies have not specifically examined neighbo

    2018-11-05

    However, prior studies have not specifically examined neighborhood racial composition or density in association with pregnancy-related weight such as weight prior to pregnancy and gestational weight gain, and the potential intersections with individual race and neighborhood income or poverty. One prior study specifically examined the intersections between residential segregation and an individual\'s race/ethnicity found that the effects of residential segregation on self-reported health were conditioned upon individual race/ethnicity (Gibbons & Yang, 2014). Another study found that high neighborhood socioeconomic disadvantage was associated with inadequate weight gain (i.e., not enough) and weight loss during pregnancy (Mendez et al., 2014). The present study examines neighborhood racial composition in association with pre-pregnancy BMI (i.e., overweight/obesity) and gestational weight gain (i.e., inadequate and excessive). Additionally, we examine whether neighborhood poverty specifically modifies the association. Given the racial disparities in overweight/obesity prior to pregnancy and inadequate weight gain during pregnancy, we hypothesize that black women living in neighborhoods that are predominately black or white will have the highest risk of inadequate weight gain and pre-pregnancy overweight/obesity compared with all other groups due to the inequitable neighborhood conditions and resultant stressors (Kramer & Hogue, 2009).
    Methods
    Results
    Discussion In this study, we found that black women living in predominately black or racially mixed neighborhoods were more likely to be obese pre- pregnancy compared with black women living in non-black/predominately white neighborhoods; and that neighborhood racial composition was not associated with gestational weight gain among black women. Our PMX 205 was that black women living in the most segregated areas will present with the greatest risk of inadequate weight gain was not supported by our findings; however, our other hypothesis that segregation would be associated with pre-pregnancy obesity was supported. We expected neighborhood racial composition to be associated with inadequate gestational weight gain due to previous studies of other pregnancy outcomes that have found that high racial/ethnic neighborhood composition or density to be associated with preterm birth and low birth weight among US-born black women (Masi et al., 2007; Mason et al., 2009). However, neighborhood racial composition, a proxy for segregation, may have more of an influence on early health factors prior to pregnancy (e.g., pre-pregnancy BMI) rather than weight gain during the short window of pregnancy. Additionally, the stressful environments hypothesized as a result of isolated, segregated neighborhoods (Williams & Collins, 2001), may be more likely to send women on a trajectory of unhealthy weight patterns even prior to pregnancy that may exude different effects on weight during the course of pregnancy. We also found that neighborhood poverty was not associated with inadequate gestational weight gain for black women but was moderately associated for white women; while neighborhood poverty was more strongly associated with pre-pregnancy obesity for white women than black women. In a previous study with a similar population, neighborhood socioeconomic disadvantage was associated inadequate weight gain among both black and white women (Mendez et al., 2014). There is an extensive body of literature that shows residents of socioeconomically disadvantaged neighborhoods, and neighborhoods with high social disorder are more likely to be obese, compared to residents of more advantaged neighborhoods (Chang, Hillier & Mehta, 2009; Glass, Rasmussen & Schwartz, 2006; Inagami et al., 2006). Although there are limited prior studies investigating neighborhood income or poverty in association with pregnancy-related weight, a European study found that pre-pregnancy obesity was associated with residence in a poor area (Sellstrom et al., 2009), and US-based studies found that residence in metropolitan areas were associated with pre-pregnancy obesity (Janevic et al., 2010; Lee et al., 2005). Finally, we hypothesized that there would be an association between neighborhood racial composition and pregnancy-related weight outcomes that would differ with varying levels of neighborhood poverty; however, there was no effect measure modification among black women and the lack of variability in neighborhood racial composition limited recombinant DNA technology analysis among white women.