PROJECT SUMMARY
Lead (Pb) is a naturally occurring metal in the environment, however; biomonitoring and epidemiologic studies
have demonstrated that there is no safe level of Pb in humans. Despite this fact, the Centers for Disease Control
and Prevention (CDC) identifies race as a known risk factor for higher exposure to Pb, with African Americans
(AAs) recognized as an overexposed group. Structural racism impacts many of the demographic characteristics
commonly associated with higher Pb exposure. Data from the Continuous National Health and Nutrition
Examination Survey (NHANES; 1999–2016) demonstrates higher Pb levels among individuals living in low-
income housing and without health insurance. The CDC also identifies pregnant women as a population at higher
risk for Pb exposure, as bioaccumulated Pb released from bone during pregnancy can cause an acute increase
in blood Pb concentration. Further, Pb exposure during pregnancy has been associated with an increased risk
for adverse birth outcomes, including preterm birth, the leading cause of infant morbidity and mortality worldwide.
AAs experience the highest rates of preterm birth, with rates nearly 50% higher than their white counterparts,
and socioeconomic status does not fully account for these disparities. We recognize that experiences of racism
uniquely impact AA women, who concurrently represent groups that are targeted by historic and current
discrimination on the basis of both race and gender. However, research has yet to elucidate determinants of
increased Pb exposure among AA women and, specifically, in the context of pregnancy. My study will leverage
the Atlanta African American Maternal Child Cohort, an ongoing, prospective birth cohort of self-identified AA
pregnant women in Atlanta. In seeking to understand root-causes of racial health disparities in maternal health,
I will take advantage of the rich extant survey data and biologic measurements of Pb. In Aim 1, I will test the
hypothesis that levels of maternal Pb are higher among those who are of lower socioeconomic status, who live
in older homes, and who live in neighborhoods that are more racially and economically segregated. In Aim 2, I
will examine associations between exposure to Pb and preterm birth and assess whether this relationship is
stronger among those who report experiencing greater frequency of gendered racial discrimination. In Aim 3, I
will return contextualized Pb exposure data back to participants through reporting back of research results
(RBRR). Participants will not only learn about the impact of Pb exposure on adverse maternal health outcomes,
including preterm birth, but will receive this information through focus groups designed in partnership with the
community and facilitated by scientific researchers. Together, these aims will fill a critical knowledge gap in
understanding racial disparities in Pb exposure and identifying risk factors for overexposed groups. The
proposed project represents an innovative and accessible approach to research in perinatal health disparities:
exploring risk identification and intervention through community-academic partnerships.
