ArticlePloS one2019
Demographic risk factors for adverse birth outcomes in Puerto Rico in the PROTECT cohort.
Article in PloS one, 2019. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 36 papers, 1 of them a synthesis that pooled it.
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Who cites it
36 citing papers in PubMed, 1 synthesis or guideline pooled it, 43 citations in OpenAlex.
- Urinary oxidative stress biomarkers are associated with preterm birth: an Environmental Influences on Child Health Outcomes program study.American journal of obstetrics and gynecology · 2023Pooled it
- Assessment of effect modification in associations between biomarkers of prenatal glyphosate exposure and child neurodevelopment in Puerto Rico.Environmental epidemiology (Philadelphia, Pa.) · 2026Article
- Maternal inflammation and oxidative stress during pregnancy in relation to early childhood neurodevelopment.Brain, behavior, and immunity · 2026Article
- Experiences of clinicians engaged in report-back of individual chemical exposures in two pregnancy cohorts.Environmental health : a global access science source · 2026Article
- Prenatal urinary biomarkers of metal and metalloid exposure and child neurodevelopmental outcomes in Puerto Rico.Environmental research · 2026Article
- Hurricane María and prenatal maternal mental health: Variations in stress, social support, and depression across disaster recovery periods in Puerto Rico.Environmental research · 2026Article
- Prevalence of Self-Reported Postpartum Depressive Symptoms and Related Factors in Women living in Puerto Rico (2017-2020).Puerto Rico health sciences journal · 2025Article
- Advanced maternal age increases the risk of adverse neonatal outcomes: a comparative study in Ethiopia.BMC pregnancy and childbirth · 2025Article
- Examining the association between gestational phenol exposure and infant non-nutritive suck in two Environmental influences on Child Health Outcomes cohorts.Environmental epidemiology (Philadelphia, Pa.) · 2025Article
- Association of Phenols, Parabens, and Their Mixture with Maternal Blood Pressure Measurements in the PROTECT Cohort.Environmental health perspectives · 2024Article
- Cross-Sectional Associations between Prenatal Per- and Poly-Fluoroalkyl Substances and Bioactive Lipids in Three Environmental Influences on Child Health Outcomes (ECHO) Cohorts.Environmental science & technology · 2024Article
- Urinary phenol and paraben concentrations in association with markers of inflammation during pregnancy in Puerto Rico.The Science of the total environment · 2024Article
- Predictive factors and adverse perinatal outcomes associated with maternal smoking status.Scientific reports · 2024Article
- Cross-sectional associations between prenatal maternal per- and poly-fluoroalkyl substances and bioactive lipids in three Environmental influences on Child Health Outcomes (ECHO) cohorts.medRxiv : the preprint server for health sciences · 2023Article
- Association between socioeconomic status with pregnancy and neonatal outcomes: An international multicenter cohort.Acta obstetricia et gynecologica Scandinavica · 2023Article
- Epidemiologic Advances Generated by the Human Health Exposure Analysis Resource Program.Current epidemiology reports · 2023Article
- Adverse neonatal outcomes and associated factors among mothers who gave birth through induced and spontaneous labor in public hospitals of Awi zone, Northwest Ethiopia: a comparative cross-sectional study.BMC pregnancy and childbirth · 2023Article
- Examining the association between prenatal maternal stress and infant non-nutritive suck.Pediatric research · 2023Article
- Pre- and peri-natal hurricane exposure alters DNA methylation patterns in children.Scientific reports · 2023Article
- Mi PROTECT: A personalized smartphone platform to report back results to participants of a maternal-child and environmental health research cohort program in Puerto Rico.PLOS digital health · 2023Article
Corrections and comments
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Authors and funding
7 authors at 5 institutions in 2 countries.
Funding
Abstract
Preterm birth is a major public health problem, especially in Puerto Rico where the rates are among the highest observed worldwide, reaching 18% in 2011. The Puerto Rico Testsite for Exploring Contamination Threats (PROTECT) study is an ongoing investigation of environmental factors that contribute to this condition. In the present analysis, we sought to examine common risk factors for preterm birth and other adverse birth outcomes which have not been characterized previously in this unique population. Pregnant women from the PROTECT cohort are recruited from the heavily contaminated Northern coast of the island of Puerto Rico and are free of pre-existing conditions like diabetes. We examined associations between basic demographic, behavioral (e.g., tobacco and alcohol use), and pregnancy (e.g., season and year of delivery) characteristics as well as municipality of residence in relation to preterm birth (<37 weeks gestation), postterm birth (≥41 weeks gestation), and small and large for gestational age in univariate and multivariate logistic regression models. Between 2011 and 2017, 1028 live singleton births were delivered as part of the PROTECT cohort. Of these, 107 (10%) were preterm. Preterm birth rates were higher among women with low socioeconomic status, as indicated by education level and income, and among women with high pre-pregnancy body mass index (BMI). Odds ratios of small for gestational age delivery were higher for women who reported tobacco use in pregnancy and lower for women who delivered in the hurricane and dengue season (July-October). Overall, in pregnant women residing in Puerto Rico, socioeconomic status was associated with preterm birth but few other factors were associated with this or other adverse outcomes of pregnancy. Research to understand environmental factors that could be contributing to the preterm birth epidemic in Puerto Rico is necessary.
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