Changing maternal income between births and risk of adverse infant outcomes
Dr. Jennifer Jairam is an Epidemiologist and a Postdoctoral Fellow at Unity Health Toronto and ICES. Working alongside Dr. Joel Ray, Clinician Scientist at Unity Health Toronto, her research is supported by an Edwin S.H. Leong Centre for Healthy Children Studentship Award and a Keenan Postdoctoral Fellow Scholarship from the St. Michael’s Hospital Foundation.
Jennifer holds a PhD in Epidemiology from the Dalla Lana School of Public Health, University of Toronto. Her PhD thesis focused on upstream social determinants of health and life-course theory, and generated new information about the risk of adverse maternal and neonatal outcomes among women living in low-income areas in Ontario (read her PhD publications online). She provides a summary of her recent postdoctoral findings in this feature.
My postdoctoral research builds on my doctoral thesis. I use data from across Ontario to study whether a mother’s downward movement to a lower income neighbourhood between births is associated with greater adversity for her infant. Prior research looked at indirect measures of newborn health -- preterm birth, abnormal birthweight and low Apgar scores -- rather than direct measures of ill health, such as severe neonatal morbidity and neonatal mortality (“SNM-M”). Canadian longitudinal studies had not examined a woman’s neighbourhood income mobility pattern and the risk of SNM-M.
Currently, I have completed three studies. The first, published in JAMA Network Open, examined whether a mother’s degree of downward movement to a lower income neighbourhood between two births was associated with her newborn being discharged to child protective services at the second birth. We found that a greater degree of downward neighbourhood income movement was associated with a higher risk of newborn discharge to child protective services.
The second study, in JAMA Pediatrics, assessed a mother’s change in neighbourhood income between two births and her newborn’s risk of SNM-M. We found that newborns of mother’s who moved to a lower income neighbourhood between births had a higher risk of SNM-M, while newborns of mothers who moved to a higher income neighbourhood between births had a lower risk of SNM-M. The third study, in the British Journal of Obstetrics and Gynaecology, explored if a mother’s risk of severe maternal morbidity and mortality (“SMM-M”) is increased by the combined influence of her pre-existing comorbidities and changing neighbourhood income between births. We found that mothers who had a greater number of pre-existing comorbidities, had a higher risk of SMM-M. Additionally, SMM-M was related to a mother changing her neighbourhood income between births, mainly among those without any pre-existing comorbidity. The publication of these two articles is forthcoming.
Without a doubt, the Edwin S.H. Leong Centre for Healthy Children Studentship Award has been invaluable to my postdoctoral research, providing me with operational funding to access ICES data and work with a strong team from The Hospital for Sick Children and the University of Toronto.
