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The immigrant birthweight paradox in an urban cohort: Role of immigrant enclaves and ambient air pollution

Journal of Exposure Science & Environmental Epidemiology volume 32, pages 571–582 (2022)Cite this article

Abstract

Background

Foreign-born Black and Latina women on average have higher birthweight infants than their US-born counterparts, despite generally worse socioeconomic indicators and prenatal care access, i.e., “immigrant birthweight paradox” (IBP). Residence in immigrant enclaves and associated social-cultural and economic benefits may be drivers of IBP. Yet, enclaves have been found to have higher air pollution, a risk factor for lower birthweight.

Objective

We investigated the association of immigrant enclaves and children’s birthweight accounting for prenatal ambient air pollution exposure.

Methods

In the Boston-based Children’s HealthWatch cohort of mother-child dyads, we obtained birthweight-for-gestational-age z-scores (BWGAZ) for US-born births, 2006–2015. We developed an immigrant enclave score based on census-tract percentages of foreign-born, non-citizen, and linguistically-isolated households statewide. We estimated trimester-specific PM2.5 concentrations and proximity to major roads based residential address at birth. We fit multivariable linear regressions of BWGAZ and examined effect modification by maternal nativity. Analyses were restricted to nonsmoking women and term births.

Results

Foreign-born women had children with 0.176 (95% CI: 0.092, 0.261) higher BWGAZ than US-born women, demonstrating the IBP in our cohort. Immigrant enclave score was not associated with BWGAZ, even after adjusting for air pollution exposures. However, this association was significantly modified by maternal nativity (pinteraction = 0.014), in which immigrant enclave score was positively associated with BWGAZ for only foreign-born women (0.090, 95% CI: 0.007, 0.172). Proximity to major roads was negatively associated with BWGAZ (−0.018 per 10 m, 95% CI: −0.032, −0.003) and positively correlated with immigrant enclave scores. Trimester-specific PM2.5 concentrations were not associated with BWGAZ.

Significance

Residence in immigrant enclaves was associated with higher birthweight children for foreign-born women, supporting the role of immigrant enclaves in the IBP. Future research of the IBP should account for immigrant enclaves and assess their spatial correlation with potential environmental risk factors and protective resources.

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Fig. 1: Analytical sample selection, Boston-based Children’s HealthWatch cohort, 2006–2015.
Fig. 2: Response functions of immigrant enclave score on the change in average first, second, and third trimester PM2.5 concentrations (μg/m3) and distance to major roads (meter), Boston-based Children’s HealthWatch cohort, 2006–2015 (N = 2514).
Fig. 3: Adjusted mean differences in birthweight-for-gestational-age z-scores for US-born and foreign-born mothers, Boston-based Children’s HealthWatch cohort, 2006–2015 (N = 2514).

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Acknowledgements

The authors thank the families and children who participated in the Boston-based Children’s HealthWatch survey, without whom these analyses would not have been possible. The authors also thank Itai Kloog, from the Ben-Gurion University of the Negev, and Joel Schwartz, from the Harvard T.H. Chan School of Public Health, for providing exposure data. Our work was part of the Center for Research on Environmental and Social Stressors in Housing Across the Life Course (CRESSH). CRESSH is a partnership between the Boston University School of Public Health and the Harvard T.H. Chan School of Public Health that studies environmental health disparities in low-income communities throughout MA.

Funding

This study was supported by the NIH/NIMHD grant (P50MD010428); NIH/NIEHS grants (T32ES007069, P30 ES000002, and R01 ES024332); and USEPA grants (RD83615601, RD83587201, and RD835872). The content of this manuscript is solely the responsibility of the grantee and does not represent official views of any funding entity. Further, no parties involved endorse the purchase of any commercial products or services discussed in this paper.

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  1. These authors contributed equally: Gary Adamkiewicz, Antonella Zanobetti.

Authors and Affiliations

  1. Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA, USA

    MyDzung T. Chu, Tamarra James-Todd, Brent A. Coull, Francine Laden, Gary Adamkiewicz & Antonella Zanobetti

  2. Department of Environmental and Occupational Health, Milken Institute School of Public Health, The George Washington University, Washington, DC, USA

    MyDzung T. Chu

  3. Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, MA, USA

    MyDzung T. Chu

  4. Department of Pediatrics, School of Medicine, Boston University, Boston, MA, USA

    Stephanie Ettinger de Cuba & Megan Sandel

  5. Department of Environmental Health, School of Public Health, Boston University, Boston, MA, USA

    M. Patricia Fabian, Kevin James Lane, Fei Carnes & Jonathan I. Levy

  6. Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA

    Tamarra James-Todd & Francine Laden

  7. Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA, USA

    David R. Williams

  8. Department of African and African American Studies, Harvard University, Cambridge, MA, USA

    David R. Williams

  9. Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA, USA

    Brent A. Coull

  10. Biostatistics and Epidemiology Data Analytics Center, School of Public Health, Boston University, Boston, MA, USA

    Marisa Massaro

  11. Channing Division of Network Medicine, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA, USA

    Francine Laden

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Contributions

MDTC: Conceptualization; Methodology; Formal analysis; Software; Visualization; Roles/Writing—original draft; Writing—review and editing. SEdC: Conceptualization; Data curation; Writing—review and editing. MPF: Conceptualization; Data curation; Writing—review and editing. KJL: Data curation; Methodology; Writing—review and editing. TJT: Conceptualization; Methodology; Writing—review and editing. DRW: Conceptualization; Methodology; Writing—review and editing. BAC: Conceptualization; Methodology; Writing—review and editing; FC: Data curation. MM: Data curation. JIL: Writing—review and editing; Funding acquisition. FLade: Writing—review and editing; Funding acquisition. MS: Writing—review and editing. GA: Conceptualization; Methodology; Formal analysis; Writing—review and editing; Supervision. AZ: Conceptualization; Funding acquisition; Data curation; Methodology; Formal analysis; Writing—review and editing.

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Correspondence to MyDzung T. Chu.

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Chu, M.T., Ettinger de Cuba, S., Fabian, M.P. et al. The immigrant birthweight paradox in an urban cohort: Role of immigrant enclaves and ambient air pollution. J Expo Sci Environ Epidemiol 32, 571–582 (2022). https://doi.org/10.1038/s41370-021-00403-8

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