{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,16]],"date-time":"2026-10-16T04:26:02Z","timestamp":1792124762776,"version":"4.4.0"},"reference-count":65,"publisher":"American Medical Association (AMA)","issue":"5","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA Netw Open"],"abstract":"Importance<\/jats:title>Residing in a low-income neighborhood is generally associated with worse pregnancy outcomes. It is not known if moving from a low- to higher-income area between 2 pregnancies alters the risk of adverse birth outcomes in the subsequent birth compared with women who remain in low-income areas for both births.<\/jats:p><\/jats:sec>Objective<\/jats:title>To compare the risk of adverse maternal and newborn outcomes among women who achieved upward area-level income mobility vs those who did not.<\/jats:p><\/jats:sec>Design, Setting, and Participants<\/jats:title>This population-based cohort study was completed in Ontario, Canada, from 2002 to 2019, where there is universal health care. Included were all nulliparous women with a first-time singleton birth at 20 to 42 weeks\u2019 gestation, each residing in a low-income urban neighborhood at the time of the first birth. All women were then assessed at their second birth. Statistical analysis was conducted from August 2022 to April 2023.<\/jats:p><\/jats:sec>Exposure<\/jats:title>Movement from a lowest-income quintile (Q1) neighborhood to any higher-income quintile neighborhood (Q2-Q5) between the first and second birth.<\/jats:p><\/jats:sec>Main Outcomes and Measures<\/jats:title>The maternal outcome was severe maternal morbidity or mortality (SMM-M) at the second birth hospitalization or up to 42 days post partum. The primary perinatal outcome was severe neonatal morbidity or mortality (SNM-M) within 27 days of the second birth. Relative risks (aRR) and absolute risk differences (aARD) were estimated by adjusting for maternal and infant characteristics.<\/jats:p><\/jats:sec>Results<\/jats:title>A total of 42\u202f208 (44.1%) women (mean [SD] age at second birth, 30.0 [5.2] years) experienced upward area-level income mobility, and 53\u202f409 (55.9%) women (age at second birth, 29.0 [5.4] years) remained in income Q1 between births. Relative to women who remained in income Q1 between births, those with upward mobility had a lower associated risk of SMM-M (12.0 vs 13.3 per 1000 births), with an aRR of 0.86 (95% CI, 0.78 to 0.93) and aARD of \u22122.09 per 1000 (95% CI, \u22123.1 to \u22120.9 per 1000 ). Likewise, their newborns experienced lower respective rates of SNM-M (48.0 vs 50.9 per 1000 live births), with an aRR of 0.91 (95% CI, 0.87 to 0.95) and aARD of \u22124.7 per 1000 (95% CI, \u22126.8 to \u22122.6 per 1000).<\/jats:p><\/jats:sec>Conclusions and Relevance<\/jats:title>In this cohort study of nulliparous women living in low-income areas, those who moved to a higher-income area between births experienced less morbidity and death in their second pregnancy, as did their newborns, compared with those who remained in low-income areas between births. Research is needed to determine whether financial incentives or enhancement of neighborhood factors can reduce adverse maternal and perinatal outcomes.<\/jats:p><\/jats:sec>","DOI":"10.1001\/jamanetworkopen.2023.15301","type":"journal-article","created":{"date-parts":[[2023,5,23]],"date-time":"2023-05-23T15:04:23Z","timestamp":1684854263000},"page":"e2315301","source":"Crossref","is-referenced-by-count":16,"title":["Neighborhood Income Mobility and Risk of Neonatal and Maternal Morbidity"],"prefix":"10.1001","volume":"6","author":[{"given":"Jennifer A.","family":"Jairam","sequence":"first","affiliation":[{"name":"Division of Epidemiology, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada"},{"name":"MAP Centre for Urban Health Solutions, St Michael's Hospital, Toronto, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Simone N.","family":"Vigod","sequence":"additional","affiliation":[{"name":"Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada"},{"name":"Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada"},{"name":"ICES, Toronto, Ontario, Canada"},{"name":"Women's College Hospital, Toronto, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Arjumand","family":"Siddiqi","sequence":"additional","affiliation":[{"name":"Division of Epidemiology, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada"},{"name":"Gillings School of Global Public Health, University of North Carolina at Chapel Hill"},{"name":"Department of Social and Behavioral Sciences, Harvard T.H. 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