Is the association between neighborhood hardship and preterm birth mediated by post-traumatic stress?

Living in a disadvantaged neighborhood contributes to adverse health outcomes, including preterm birth (PTB). Mechanisms for this association are unclear but understanding them is essential to informing interventions to mitigate health disparities. Recognizing the high prevalence of post-traumatic stress disorder (PTSD) within high hardship neighborhoods, our objective was to identify whether PTSD symptoms mediate the relationship between neighborhood hardship and PTB. This retrospective cohort study included all pregnant and postpartum people referred to a perinatal collaborative care (CC) program for mental health care who delivered at a single quaternary care hospital between 2016 and 2021. All individuals referred to the CC program received a PCL-C screen at intake to assess PTSD symptoms. ArcGIS was used to geocode CC participant addresses; these geocodes were linked to the national Area Deprivation Index (ADI) and divided into quartiles of neighborhood hardship. Bivariable and hierarchical multivariable analyses were performed, including mediation analyses. Characteristics of the 1998 individuals who met inclusion criteria, stratified by neighborhood hardship quartile, are shown in Table 1. The incidence of PTB was 12%, 11%, 18%, and 25% in each quartile of increasing neighborhood hardship (p< 0.001). After controlling for neighborhood and individual-level confounders via hierarchical regression, compared to those living in the lowest quartile, those living in the highest quartile of neighborhood hardship had a nearly two-fold increased odds of PTB (Table 2). In mediation analyses, 39% of the relationship between neighborhood hardship and PTB was mediated by PTSD symptoms. Living in a neighborhood with higher hardship defined by the ADI is associated with an increased incidence of PTB. This association is partially mediated by post-traumatic stress symptoms. Future research should evaluate trauma-informed care as well as identification and treatment of PTSD symptoms as interventions to mitigate health disparities in PTB.View Large Image Figure ViewerDownload Hi-res image Download (PPT)