Impacts of perceived neighborhood safety on birth outcomes

Impacts of perceived neighborhood safety on birth outcomes | Image Credit: © arinahabich - © Jarinahabich - stock.adobe.com.

According to a recent study published in JAMA Network Open, poorer perceived neighborhood safety is associated with decreased utilization of prenatal care.

Impacts on birth weight, preterm birth, perinatal depression, small-for-gestational-age neonates, and prenatal care quality have been observed from neighborhood-level exposures. Individuals with poor neighborhood safety perception are at an increased risk of higher blood pressure, higher stress levels, reduced physical activity, and increased smoking and alcohol consumption.

To determine if poor perceived neighborhood safety is associated with adverse birth outcomes, investigators conducted a cross-sectional study using the Pregnancy Risk Assessment Monitoring System, which performs surveys 2 to 4 months following delivery. Data on perceived neighborhood safety was collected in surveys from 2016 to 2020.

Surveys assessing neighborhood safety asked, “During the 12 months before your new baby was born, how often did you feel unsafe in the neighborhood where you lived?” Responses included always or often unsafe, sometimes unsafe, rarely unsafe, and never unsafe. Data was weighted based on the state population of live, singleton births.

Birth outcomes such as self-reported depressive symptoms during pregnancy or postpartum, low birth weight, breastfeeding for at least 8 weeks, and attending over 8 prenatal care visits were assessed. The independent significance of neighborhood safety was evaluated using multivariable logistic and Poisson regression models.

Of the 29,987 respondents included in the final analysis, 16.3% were non-Hispanic Black, 12.5% were Hispanic, 63.4% had over 12 years of education, 37.3% had an annual household income over $60,000, 23.7% had births covered by Medicaid, 14.2% had a history of depression, and 35.5% reported pregnancy abuse.

Obesity was reported in 27.3% of participants, pregnancy smoking in 18.7%, hypertensive disorders of pregnancy in 12.9%, and gestational diabetes in 9.3%. Never feeling unsafe was reported by 78% of participants, rarely feeling unsafe by 13.7%, sometimes feeling unsafe by 5.3%, and often or always feeling unsafe by 3%.

Neonates with low birth weight were seen in 6.5% of respondents, perinatal depressive symptoms in 21%, over 8 prenatal care visits in 85.9%, a postpartum visit in 89.5%, and at least 8 weeks of breastfeeding in 53.9%. Low birth weight rates were 23% higher in those always or often feeling unsafe, while the risks of perinatal depressive symptoms were 100% higher and the chances of attending over 8 prenatal care visits 10% lower.

Overall, feeling often or always unsafe was associated with less utilization of prenatal care. Investigators recommended social and economic policies to reduce neighborhood violence and improve feelings of safety during pregnancy.

Reference

Carter JG, Feinglass JM, Yee LM. Perception of Neighborhood Safety and Maternal and Neonatal Health Outcomes. JAMA Netw Open. 2023;6(5):e2317153. doi:10.1001/jamanetworkopen.2023.17153