| BACKGROUND: The social causation of preterm birth remains elusive, without an adequate explanatory framework. Thus, this study proposed and evaluated a conceptual model of the social determinants of perinatal health for the understanding of perinatal health disparities.;METHODS: A prospective cohort study was conducted with pregnant women between 20 and 35 weeks gestation who were participating in two Healthy Start programs in Central Florida, from July 2011-August 2013. Perinatal health was operationalized based on gestational age, birth weight, and healthy start infant risk screen score. The predictors were: early life adversity, social position, maternal health-related quality of life, maternal stress, racism and discrimination, lack of social support, father involvement during pregnancy, intimate partner violence, and adverse maternal behaviors. Data collection consisted of a self-administered survey and birth outcome data was obtained from Healthy Start administrative databases. The statistical framework was structural equation modeling.;RESULTS: The study sample was racially and ethnically diverse (N, Hispanics=72; N, non-Hispanic blacks=61; and N, non-Hispanic whites=48). The majority of mothers in this study were single or not married (cumulative 76%), US born (74.6%), and with English speaking preference (74.6%). The sample tended to cluster in low income groups (cumulative 58% less than ;CONCLUSION: This study demonstrated synergistic effects of social determinants of health. Controlling for all factors considered, social support was significantly associated with perinatal health, which presents implications for strengthening prenatal programs that provide support to pregnant women. Findings need to be replicated in larger studies with the US general population. Policy makers and researchers need to pay greater attention to the role of early life adversity on perinatal health outcomes. |
