The impact of social determinants of health on infant and maternal health using a reproductive justice lens
Abstract Background Rates of preterm birth, low birth weight, and Neonatal Intensive Care Unit (NICU) admissions continue to rise in the United States (US). Social determinants of health (SDOH) are recognized as significant contributors to infant and maternal health, underscoring the need for use of...
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| Format: | Article |
| Language: | English |
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BMC
2025-05-01
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| Series: | BMC Pregnancy and Childbirth |
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| Online Access: | https://doi.org/10.1186/s12884-025-07693-y |
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| author | Kathryn J. Malin Ashelee J. Vance Stephanie E. Moser Jessica Zemlak Cherise Edwards Rosemary White-Traut Rebecca Koerner Jacqueline McGrath Kelly McGlothen-Bell |
| author_facet | Kathryn J. Malin Ashelee J. Vance Stephanie E. Moser Jessica Zemlak Cherise Edwards Rosemary White-Traut Rebecca Koerner Jacqueline McGrath Kelly McGlothen-Bell |
| author_sort | Kathryn J. Malin |
| collection | DOAJ |
| description | Abstract Background Rates of preterm birth, low birth weight, and Neonatal Intensive Care Unit (NICU) admissions continue to rise in the United States (US). Social determinants of health (SDOH) are recognized as significant contributors to infant and maternal health, underscoring the need for use of research frameworks that incorporate SDOH concepts. The Restoring Our Own Through Transformation (ROOTT) theoretical framework is rooted in reproductive justice (i.e. reproductive rights and social justice-based framework) and emphasizes both structural and social determinants as root causes of health inequities. The impact of SDOH on maternal and infant mortality and morbidity can often be traced to structural determinants unique to the US, including slavery, Jim Crow laws, redlining, and the GI Bill. Aims Using data from the Pregnancy Risk Assessment Monitoring System (PRAMS) 8 database, we aimed to evaluate relationships between SDOH (as guided by the ROOTT Framework) and maternal and infant health outcomes. Methods Data were analyzed from 11 states that included the SDOH supplement in their PRAMS 8 data collection. We used bivariate analyses to examine relationships between SDOH measures guided by the ROOTT framework (e.g. abuse during pregnancy, access to prenatal care, housing stability and education) and maternal morbidity (i.e., gestational hypertension and gestational diabetes) and infant outcomes (i.e., preterm birth, NICU admission, breastfeeding). Pre-identified covariates were controlled for in the logistic and linear regression models. Results Preterm birth, NICU admission, breastfeeding, and maternal morbidities were significantly associated with SDOH measures linked to structural determinants in the US. Abuse during pregnancy, access to prenatal care, housing, and education were all significantly associated with poorer infant health outcomes in the final regression models. Women who received prenatal care beginning in the 3rd trimester were twice as likely to develop gestational hypertension. Conclusions SDOHs rooted in structural determinants are important predictors of poorer maternal and infant health outcomes. Evaluating health outcomes using a reproductive justice framework reveals modifiable risk factors, including access to stable healthcare, safety, and housing. Comprehensive healthcare provision must ensure early and consistent access to healthcare and resources for safety and housing stability to support maternal and infant health. |
| format | Article |
| id | doaj-art-b7705c8f16b641299bbd8107cc161d0c |
| institution | OA Journals |
| issn | 1471-2393 |
| language | English |
| publishDate | 2025-05-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Pregnancy and Childbirth |
| spelling | doaj-art-b7705c8f16b641299bbd8107cc161d0c2025-08-20T02:25:17ZengBMCBMC Pregnancy and Childbirth1471-23932025-05-0125111610.1186/s12884-025-07693-yThe impact of social determinants of health on infant and maternal health using a reproductive justice lensKathryn J. Malin0Ashelee J. Vance1Stephanie E. Moser2Jessica Zemlak3Cherise Edwards4Rosemary White-Traut5Rebecca Koerner6Jacqueline McGrath7Kelly McGlothen-Bell8Marquette University, College of NursingHenry Ford Health Center for Health Policy & Health Services ResearchIndependent Statistical ConsultingMarquette University, College of NursingMarquette University, College of NursingDepartment of Nursing Research, Children’s Wisconsin, The University of Chicago IllinoisThe University of South FloridaThe University of TexasThe University of TexasAbstract Background Rates of preterm birth, low birth weight, and Neonatal Intensive Care Unit (NICU) admissions continue to rise in the United States (US). Social determinants of health (SDOH) are recognized as significant contributors to infant and maternal health, underscoring the need for use of research frameworks that incorporate SDOH concepts. The Restoring Our Own Through Transformation (ROOTT) theoretical framework is rooted in reproductive justice (i.e. reproductive rights and social justice-based framework) and emphasizes both structural and social determinants as root causes of health inequities. The impact of SDOH on maternal and infant mortality and morbidity can often be traced to structural determinants unique to the US, including slavery, Jim Crow laws, redlining, and the GI Bill. Aims Using data from the Pregnancy Risk Assessment Monitoring System (PRAMS) 8 database, we aimed to evaluate relationships between SDOH (as guided by the ROOTT Framework) and maternal and infant health outcomes. Methods Data were analyzed from 11 states that included the SDOH supplement in their PRAMS 8 data collection. We used bivariate analyses to examine relationships between SDOH measures guided by the ROOTT framework (e.g. abuse during pregnancy, access to prenatal care, housing stability and education) and maternal morbidity (i.e., gestational hypertension and gestational diabetes) and infant outcomes (i.e., preterm birth, NICU admission, breastfeeding). Pre-identified covariates were controlled for in the logistic and linear regression models. Results Preterm birth, NICU admission, breastfeeding, and maternal morbidities were significantly associated with SDOH measures linked to structural determinants in the US. Abuse during pregnancy, access to prenatal care, housing, and education were all significantly associated with poorer infant health outcomes in the final regression models. Women who received prenatal care beginning in the 3rd trimester were twice as likely to develop gestational hypertension. Conclusions SDOHs rooted in structural determinants are important predictors of poorer maternal and infant health outcomes. Evaluating health outcomes using a reproductive justice framework reveals modifiable risk factors, including access to stable healthcare, safety, and housing. Comprehensive healthcare provision must ensure early and consistent access to healthcare and resources for safety and housing stability to support maternal and infant health.https://doi.org/10.1186/s12884-025-07693-yPRAMSAccessPregnancyPerinatal healthMaternal healthSocial determinants of health |
| spellingShingle | Kathryn J. Malin Ashelee J. Vance Stephanie E. Moser Jessica Zemlak Cherise Edwards Rosemary White-Traut Rebecca Koerner Jacqueline McGrath Kelly McGlothen-Bell The impact of social determinants of health on infant and maternal health using a reproductive justice lens BMC Pregnancy and Childbirth PRAMS Access Pregnancy Perinatal health Maternal health Social determinants of health |
| title | The impact of social determinants of health on infant and maternal health using a reproductive justice lens |
| title_full | The impact of social determinants of health on infant and maternal health using a reproductive justice lens |
| title_fullStr | The impact of social determinants of health on infant and maternal health using a reproductive justice lens |
| title_full_unstemmed | The impact of social determinants of health on infant and maternal health using a reproductive justice lens |
| title_short | The impact of social determinants of health on infant and maternal health using a reproductive justice lens |
| title_sort | impact of social determinants of health on infant and maternal health using a reproductive justice lens |
| topic | PRAMS Access Pregnancy Perinatal health Maternal health Social determinants of health |
| url | https://doi.org/10.1186/s12884-025-07693-y |
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