Racial Inequities in Birth Weight by Maternal Age Among College-Educated Mothers: The Role of Early Disadvantage


Koning, Stephanie M.; Polos, Jessica A.; Kershaw, Kiarri N.; & McDade, Thomas W. (2022). Racial Inequities in Birth Weight by Maternal Age Among College-Educated Mothers: The Role of Early Disadvantage. American Journal of Preventive Medicine. , PMCID: PMC9035061


Introduction Non-Hispanic Black infants experience disproportionately high risks of low birth weight compared with non-Hispanic White infants, particularly among mothers with high educational attainment and greater socioeconomic advantage. This study investigates how maternal early-life disadvantage contributes to ongoing racial birth weight inequities among U.S. college‒educated mothers, specifically declining birth weights with age among non-Hispanic Black mothers. Methods Study analyses used cohort data from the National Longitudinal Study of Adolescent to Adult Health. Racial inequities in birth weight by maternal age and early-life disadvantage were assessed using completed reproductive histories among college-educated mothers at ages 33–44 years collected in 2016‒2018 and regression-based marginal standardization techniques. Early-life disadvantage was measured using a study-based composite measure of early-life concentrated poverty and social disadvantage in homes, neighborhoods, and schools, collected in previous waves. Primary analyses were completed in 2020‒2021. Results Among non-Hispanic Black mothers who experienced high early-life disadvantage, a 1-year increase in maternal age at delivery was associated with lower birth weight by 26.07 g (95% CI= −48.74, −3.40). Similar declines were not found among non-Hispanic Black mothers with low early-life disadvantage. Non-Hispanic White mothers experienced increased birth weight with maternal age, 6.85 g (95% CI= −1.12, 14.82) per year, which did not significantly vary by early-life disadvantage. Conclusions Early-life disadvantage modifies whether and how college-educated mothers experience birth weight decline with older age. The effects of early-life contexts and embedded racial inequities on maternal health inequities and differential weathering warrant further public health attention.




racial inequality

Reference Type

Journal Article

Journal Title

American Journal of Preventive Medicine


Koning, Stephanie M.
Polos, Jessica A.
Kershaw, Kiarri N.
McDade, Thomas W.

Year Published






Reference ID