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Participants\u2019 addresses were linked to area-level measures of life expectancy, education, unemployment, health insurance, jail rate, segregation, and housing cost burden. We created absolute measures to represent economic disadvantage and relative measures comparing values for Black or Latinx people to White people in the same area to represent structural racism. We used quantile G-computation to estimate the effects of a one-quartile increase in all exposures simultaneously on fetal growth and gestational age measures. A one-quartile increase in economic disadvantage was associated with a reduction in birthweight [(-25.65 grams, 95% CI (-45.83, -5.48)], but not gestational age [-0.02\u00a0weeks, 95% CI (-0.13, 0.09)]. With a one-quartile increase in Latinx\u2013White structural racism, we observed reductions in birthweight [-80.83, 95% CI (-143.42, -18.23)] among Latinx participants. A one-quartile increase in Black\u2013White structural racism was weakly associated with lower birthweight among Black participants [-15.70, 95% CI (-82.89, 51.48)] but was associated with higher birthweight among White participants [57.47, 95% CI (13.26, 101.67)]. Our findings suggest co-occurring forms of structural inequity likely influence racialized disparities in fetal growth outcomes.<\/jats:p>","DOI":"10.1093\/aje\/kwaf224","type":"journal-article","created":{"date-parts":[[2025,10,18]],"date-time":"2025-10-18T11:44:19Z","timestamp":1760787859000},"page":"464-476","source":"Crossref","is-referenced-by-count":1,"title":["Applying mixtures methodology to analyze how exposure to structural racism and economic disadvantage affect perinatal health outcomes: an ECHO study"],"prefix":"10.1093","volume":"195","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7557-7977","authenticated-orcid":false,"given":"Dana E","family":"Goin","sequence":"first","affiliation":[{"name":"Department of Epidemiology, Columbia University Mailman School of Public Health , New York, NY ,","place":["United States"]},{"name":"Department of Obstetrics, Gynecology, and Reproductive Sciences, Program on Reproductive Health and the Environment, School of Medicine, UCSF , San Francisco, CA ,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ronel","family":"Ghidey","sequence":"additional","affiliation":[{"name":"ECHO Data Analysis Center, Johns Hopkins Bloomberg School of Public Health , Baltimore, MD ,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Holly","family":"Schuh","sequence":"additional","affiliation":[{"name":"Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health , Baltimore, MD ,","place":["United States"]},{"name":"Institute for Vaccine Safety, Johns Hopkins Bloomberg School of Public Health , Baltimore, MD ,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lorraine T","family":"Dean","sequence":"additional","affiliation":[{"name":"Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health , Baltimore, MD ,","place":["United 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