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Allostatic Load, Neighborhood Disadvantage, and Birth Outcomes
Cynthia Wynn1, Jiashu Zhao2, Michael Petriello3
1Department of Family Medicine, University of Michigan, Ann Arbor, MI, USA. clwynn@med.umich.edu.
Journal of Racial and Ethnic Health Disparities
|July 28, 2026
Summary
Neighborhood disadvantage showed trends toward preterm birth (PTB) but effects were not significant. Allostatic load (AL) was higher in Black pregnant individuals, but did not mediate the association between neighborhood disadvantage and PTB.
Area of Science:
- Environmental Health
- Reproductive Health
- Health Disparities
Background:
- Neighborhood disadvantage, measured by the Index of Concentration at the Extremes, is a potential social determinant of preterm birth (PTB).
- Allostatic load (AL), a measure of cumulative physiological wear and tear, may mediate the relationship between disadvantage and adverse birth outcomes.
- Understanding these associations is crucial for developing targeted interventions to reduce PTB, particularly among vulnerable populations.
Purpose of the Study:
- To investigate the association between neighborhood disadvantage and PTB.
- To assess whether AL mediates the relationship between neighborhood disadvantage and PTB.
Main Methods:
- Prospective cohort study using data from the Michigan Archive for Research on Child Health (2016 onwards).
- Operationalized AL using eight parameters from inflammatory biomarkers and prenatal records, dichotomized as high (≥4) or low (<4).
- Generalized Estimating Equations models clustered by zip code were used to test for mediation by AL.
Main Results:
- No statistically significant association was found between neighborhood disadvantage and PTB for Black or non-Black pregnant individuals.
- Living in more privileged areas was significantly associated with lower odds of high AL (OR=0.30).
- While trends suggested higher PTB odds with high AL scores, these were not statistically significant for either group.
Conclusions:
- Observed trends indicate neighborhood disadvantage may influence PTB, but the effects did not reach statistical significance in this cohort.
- Black pregnant individuals exhibited higher AL, but AL did not mediate the association between neighborhood disadvantage and PTB.
- Further research with larger sample sizes may be needed to confirm these associations and explore other potential mediators.
Keywords:
Index of Concentration at the ExtremesAllostatic loadBirth outcomesHealth disparitiesNeighborhood disadvantagePreterm birthMore Related Videos
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