{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,31]],"date-time":"2026-07-31T08:55:02Z","timestamp":1785488102168,"version":"3.56.0"},"reference-count":40,"publisher":"Wiley","issue":"2","license":[{"start":{"date-parts":[[2025,2,27]],"date-time":"2025-02-27T00:00:00Z","timestamp":1740614400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100009633","name":"Eunice Kennedy Shriver National Institute of Child Health and Human Development","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100009633","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100008199","name":"RTI International","doi-asserted-by":"publisher","award":["U10HD063036"],"award-info":[{"award-number":["U10HD063036"]}],"id":[{"id":"10.13039\/100008199","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100008136","name":"Case Western Reserve University","doi-asserted-by":"publisher","award":["U10 HD063072"],"award-info":[{"award-number":["U10 HD063072"]}],"id":[{"id":"10.13039\/100008136","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100006474","name":"Columbia University","doi-asserted-by":"publisher","award":["U10 HD063047"],"award-info":[{"award-number":["U10 HD063047"]}],"id":[{"id":"10.13039\/100006474","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100006733","name":"Indiana University","doi-asserted-by":"publisher","award":["U10 HD063037"],"award-info":[{"award-number":["U10 HD063037"]}],"id":[{"id":"10.13039\/100006733","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100007921","name":"University of Pittsburgh","doi-asserted-by":"publisher","award":["U10HD063041"],"award-info":[{"award-number":["U10HD063041"]}],"id":[{"id":"10.13039\/100007921","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100007059","name":"Northwestern University","doi-asserted-by":"publisher","award":["U10 HD063020"],"award-info":[{"award-number":["U10 HD063020"]}],"id":[{"id":"10.13039\/100007059","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100006920","name":"University of Pennsylvania","doi-asserted-by":"publisher","award":["U10 HD063048"],"award-info":[{"award-number":["U10 HD063048"]}],"id":[{"id":"10.13039\/100006920","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100007747","name":"University of Utah","doi-asserted-by":"publisher","award":["U10 HD063053"],"award-info":[{"award-number":["U10 HD063053"]}],"id":[{"id":"10.13039\/100007747","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100008476","name":"University of California, Irvine","doi-asserted-by":"publisher","award":["UL1TR000153"],"award-info":[{"award-number":["UL1TR000153"]}],"id":[{"id":"10.13039\/100008476","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100008476","name":"University of California, Irvine","doi-asserted-by":"publisher","award":["U10 HD063046"],"award-info":[{"award-number":["U10 HD063046"]}],"id":[{"id":"10.13039\/100008476","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000968","name":"American Heart Association","doi-asserted-by":"publisher","award":["22HERNCMI980273"],"award-info":[{"award-number":["22HERNCMI980273"]}],"id":[{"id":"10.13039\/100000968","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Pregnancy"],"published-print":{"date-parts":[[2025,3]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Introduction<\/jats:title><jats:p>Individual\u2010 and neighborhood\u2010level social determinants of health (SDOH) have been assessed separately in pregnancy, but their relationship to one another remains uncertain. We investigated the intersectionality of three neighborhood\u2010level SDOH measures with three individual\u2010level SDOH measures. This was done to examine the concomitant experiences of multiple SDOH in pregnancy.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>A secondary analysis of data from the Nulliparous Pregnancy Outcomes Study: Monitoring Mothers\u2010To\u2010Be. We assessed three neighborhood\u2010level SDOH measures using geocoded participant home addresses in the first trimester at the census\u2010tract level: (1) high socioeconomic disadvantage (in tertiles) by the 2015 Area Deprivation Index, (2) inadequate food access by the USDA <jats:italic>Food Access Research Atlas<\/jats:italic>, and (3) low walkability by the EPA National Walkability Score. We assessed three individual\u2010level SDOH measures: low household income, lower educational attainment, and Medicaid insurance. We examined the combinations of these three neighborhood SDOH and three individual SDOH measures by graphical visualization and using statistical tests to assess overall differences in the distribution of these measures.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Of 9588 nulliparous individuals, adverse neighborhood\u2010level SDOH [high socioeconomic disadvantage (28%), inadequate food access (24%), and low walkability (66%)] and adverse individual\u2010level SDOH [low household income (19%), lower educational attainment (23%), and Medicaid insurance (33%)] were common in early pregnancy. Six percent of individuals lived in a community with all three adverse neighborhood\u2010level SDOH measures. Of those living in a community with at least two neighborhood\u2010level SDOH measures, 23% lived in areas with inadequate food access and low walkability, 19% with high socioeconomic disadvantage and low walkability, and 1% with high socioeconomic disadvantage and inadequate food access. Overall, 23% lived in a community with no adverse neighborhood\u2010level SDOH, and among this group, 88% had no adverse individual\u2010level SDOH. There were significant differences in adverse individual\u2010level SDOH based on whether individuals lived in a community with all three adverse neighborhood\u2010level measures [low household income (39%), lower educational attainment (44%), Medicaid (55%)], any two measures [low household income (22%), lower educational attainment (27%), Medicaid (37%)], or only one measure [low household income (14%), lower educational attainment (17%), Medicaid (27%)] (<jats:italic>p<\/jats:italic>\u00a0&lt;\u00a00.001 for all).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Among nulliparous individuals in early pregnancy, the frequency of adverse individual\u2010level SDOH was generally higher when they lived in communities with more adverse neighborhood\u2010level SDOH. Future approaches that identify and classify the multifaceted and multilevel nature of structural determinants as they relate to pregnancy outcomes are needed.<\/jats:p><\/jats:sec>","DOI":"10.1002\/pmf2.70002","type":"journal-article","created":{"date-parts":[[2025,3,12]],"date-time":"2025-03-12T05:25:16Z","timestamp":1741757116000},"source":"Crossref","is-referenced-by-count":3,"title":["Intersectionality of individual and neighborhood\u2010level adverse social determinants of health in early pregnancy"],"prefix":"10.1002","volume":"1","author":[{"given":"Jameaka L.","family":"Hamilton","sequence":"first","affiliation":[{"name":"Department of Obstetrics and Gynecology The Ohio State University  Columbus Ohio USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"William A.","family":"Grobman","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology The Ohio State University  Columbus Ohio 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Obstetrics and Gynecology Case Western Reserve University  Cleveland Ohio USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hyagriv","family":"Simhan","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology University of Pittsburgh  Pittsburgh Pennsylvania USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Uma","family":"Reddy","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology Columbia University  New York New York USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Robert M.","family":"Silver","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology University of Utah  Salt Lake City Utah USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Samuel","family":"Parry","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology University of Pennsylvania  Philadelphia Pennsylvania USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"George","family":"Saade","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology University of Texas Medical Branch  Galveston Texas USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jun","family":"Wu","sequence":"additional","affiliation":[{"name":"Department of Environmental and Occupational Health University of California, Irvine  Orange California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Courtney D.","family":"Lynch","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology The Ohio State University  Columbus Ohio USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kartik K.","family":"Venkatesh","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology The Ohio State University  Columbus Ohio 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