Neighborhood poverty, allostatic load, and birth outcomes in African American and white women: findings from the Bogalusa Heart Study.

As a biologically-mediated pathway between adversity and declines in physical health, allostatic load has been frequently hypothesized as a potential contributor to racial disparities in birth outcomes, but an empirical evidence is lacking. The purpose of this study was to examine the relationships between maternal preconception allostatic load, race, and adverse birth outcomes within the context of neighborhood-level poverty using data from the Bogalusa Heart Study. Allostatic load was quantified as a count of regulatory biomarkers falling in the highest risk quartile of the sample distribution as measured from a physical examination that took place prior to conception. Consistent with previous findings, African American women resided in more impoverished neighborhoods and had higher allostatic load scores compared to whites; however, allostatic load was not associated with preterm birth or low birth weight in fully adjusted models. These results underscore a need for further refinement of both biologic and contextual measures that capture holistically the way in which stressful conditions and experiences encountered across the life-course influence health potentials and engender inequities in reproductive health outcomes.