P0678 - Familial Educational Attainment and Racial Disparities in Low Birthweight Infants

Background
Compared to white women, black women are 1.5 times more likely to deliver a premature infant and 2 times more likely to deliver a low birthweight (LBW) infant. Social determinants of health are likely responsible for the majority of racial disparities in pregnancy outcomes, potentially mediated by epigenetic mechanisms and best studied with intergenerational models. Studies from the early 1990s suggest that education has less of an impact on pregnancy outcomes of black women compared to white women. The effect improved education has on pregnancy outcomes of black women over generations has been poorly studied.

Objective
To evaluate the effect of grandparent and parent educational attainment on low birthweight in children and grandchildren.

Methods
The National Longitudinal Study of Adolescent to Adult Health is a multi-generational study that collected survey data from 1994-2018. Using this database, we constructed a cohort of 5,735 grandparent-parent-child triads to evaluate how education impacts the likelihood of having LBW children and grandchildren, while adjusting for socioeconomic and maternal health factors using multivariate logistic regression.

Results
Participant characteristics stratified by race and education are shown in Table 1. Irrespective of race, parent and grandparent college education was associated with decreased odds of LBW children and grandchildren (OR 0.52, p-value <0.0001, 95% CI 0.39-0.70 and OR 0.61, p-value 0.002, 95% CI 0.46-0.84, respectively). Similar to prior studies, black women were more likely to have LBW descendants. In multivariate analysis, grandparent and parent college education were associated with a decreased odds of LBW after adjusting for individual, community, and health factors. There was no statistically significant difference in this effect between non-Hispanic white and non-Hispanic black populations. When grandparent and parent education were examined together, each remained associated with lower odds of LBW (Table 2).

Conclusion
Educational attainment across generations leads to decreased odds of LBW descendants regardless of race. The positive impact of education persists after adjusting for multiple individual, community, and health covariates. Targeting improvements in education may ameliorate adverse pregnancy outcomes that disproportionately affect minority communities and cause significant lifelong consequences.