The influence of maternal life course exposure to neighborhood affluence and disadvantage on Black/White disparities in adverse birth outcomes in South Carolina.

Exposure of mothers to neighborhood affluence or disadvantage during their childhood or adulthood may influence infant birth outcomes. Concurrently, these neighborhood exposures may be differently prevalent and impactful on health by race. Using a multigenerational dataset of maternally linked birth certificates from South Carolina (1989-2020), we investigated associations between maternal life course neighborhood exposure to affluence (neighborhood college completion) and disadvantage (neighborhood poverty) and infant low birth weight (LBW) and preterm birth (PTB), and differences by maternal Black/White race. Black women had a higher prevalence of LBW and PTB than White women, overall and within every exposure category. Black women were more often exposed to neighborhood disadvantage (high poverty), and less often exposed to neighborhood affluence (high college completion), in childhood and in adulthood than White women. Life course high (vs. low) affluence and low (vs. high) disadvantage neighborhood exposures were protectively associated with LBW, though only the latter was protective for PTB. Though we did not find evidence of differential vulnerability by maternal race to life course neighborhood exposures, the greater life course exposure of Black mothers to less affluent and more disadvantaged neighborhoods explained up to 9% of racial disparities even without effect modification present.