PROJECT SUMMARY/ABSTRACT:
This proposed study assesses how social contextual stressors over the maternal pre-pregnancy life course
contribute to the unacceptably wide racialized inequities in maternal and infant health in the United States
(US). It aims at uncovering whether and how adolescent girls’ social developmental contexts shape biosocial
stress pathways affecting maternal health and birth outcomes. It uses secondary analysis of newly available
data from the National Longitudinal Study of Adolescent to Adult Health (Add Health), a novel, US-representa-
tive longitudinal cohort with five data collection waves beginning in adolescence and including social, contex-
tual, health, and birth outcome measures. The central hypothesis is that adolescence is a pivotal early-life pe-
riod for racialized social stressors before pregnancy that affect future maternal and infant health, including
through pathways associated with accelerated maternal aging and stress-related weathering that may have
lasting impacts on maternal mental health. This hypothesis is based on early analyses by the study team re-
vealing age-related declines in birth weight and increases in maternal depression risk among Black, but not
White, mothers in Add Health—particularly when exposed to more severe early-life disadvantage. The pro-
posed analyses will further investigate aspects of adolescent contexts, linked lives over the life course, and
biosocial stress mechanisms that may serve as leverage points for future research and interventions to
achieve maternal and infant health equity. The study team will analyze Add Health cohort data spanning all five
collection waves, from ages 12 to 43, including new epigenetic markers of maternal stress and aging. With an
established collaboration record working with Add Health, the team comprises collective expertise in biosocial
frameworks, maternal and infant health, racialized health inequities, social stress, and biomarker analysis.
The study has three aims: (1) identify how contextual early-life disadvantage (ELD) contributes to ra-
cialized birth outcome ineq-uities through pre-pregnancy stress pathways; (2) identify how ELD shapes racial-
ized inequities in post-childbirth maternal stress, mental health, and accelerated aging through pre-pregnancy
stress pathways; and (3) determine the extent to which adolescent contextual risk and protective factors ex-
plain or modify racialized maternal and birth outcome inequities, and the role of ELD. It focuses on social
stress domains that are sensitive to racialized inequities and that carry implications for early-life interventions
for achieving maternal and infant health equity. It is innovative by measuring and analyzing pre-pregnancy
stress trajectories prospectively over the life course in a US-representative cohort with detailed social contextual
data and new biomarkers of maternal stress and aging after childbirth.
