Neighborhood risk and infant health

The rising trends in the incidence of preterm birth, low birth weight and very low birth weight in the United States over the last two decades has prompted in-depth investigations into the populations most affected and the neighborhoods in which mothers reside and unhealthy infants are born. In the United States, African American mothers are twice as likely as mothers of other racial and ethnic groups to have a preterm and/or low birth weight infant, the phenomenon of which cannot be explained by maternal and infant characteristics alone. There is increasing evidence that maternal exposure to structural factors that sort African Americans into racially segregated neighborhoods also increase the risk of adverse birth outcomes, independent of individual-level differences and area-level poverty. Mothers living in racially segregated urban neighborhoods also experience higher levels and more frequent exposures to crime and environmental contaminants. Stressors associated with the interaction of segregation and poverty (i.e., concentrated poverty) can increase the susceptibility of individuals living in these neighborhoods to the adverse health effects of crime-related stressors and contaminants. This article reviews social and physical risks in the urban neighborhood environment that threaten infant health. The ability of high quality preconception, prenatal and neonatal-perinatal health care to offset some of the detrimental effects associated with neighborhood risks is also discussed.