Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ASCO Annual Meeting 2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

2024 ASCO Annual Meeting

Keep up to date with all the top stories and latest evidence with our hub page, including official congress videos and expert takeaways.
ADVANCED SEARCH
Log in
Top
BMC Pregnancy and Childbirth
Published in: BMC Pregnancy and Childbirth 1/2021

01-12-2021 | Postpartum Depression | Research

Identifying urban built environment factors in pregnancy care and maternal mental health outcomes

Authors: Yiye Zhang, Mohammad Tayarani, Shuojia Wang, Yifan Liu, Mohit Sharma, Rochelle Joly, Arindam RoyChoudhury, Alison Hermann, Oliver H. Gao, Jyotishman Pathak

Published in: BMC Pregnancy and Childbirth | Issue 1/2021

Login to get access

Abstract

Backgrounds

Risk factors related to the built environment have been associated with women’s mental health and preventive care. This study sought to identify built environment factors that are associated with variations in prenatal care and subsequent pregnancy-related outcomes in an urban setting.

Methods

In a retrospective observational study, we characterized the types and frequency of prenatal care events that are associated with the various built environment factors of the patients’ residing neighborhoods. In comparison to women living in higher-quality built environments, we hypothesize that women who reside in lower-quality built environments experience different patterns of clinical events that may increase the risk for adverse outcomes. Using machine learning, we performed pattern detection to characterize the variability in prenatal care concerning encounter types, clinical problems, and medication prescriptions. Structural equation modeling was used to test the associations among built environment, prenatal care variation, and pregnancy outcome. The main outcome is postpartum depression (PPD) diagnosis within 1 year following childbirth. The exposures were the quality of the built environment in the patients’ residing neighborhoods. Electronic health records (EHR) data of pregnant women (n = 8,949) who had live delivery at an urban academic medical center from 2015 to 2017 were included in the study.

Results

We discovered prenatal care patterns that were summarized into three common types. Women who experienced the prenatal care pattern with the highest rates of PPD were more likely to reside in neighborhoods with homogeneous land use, lower walkability, lower air pollutant concentration, and lower retail floor ratios after adjusting for age, neighborhood average education level, marital status, and income inequality.

Conclusions

In an urban setting, multi-purpose and walkable communities were found to be associated with a lower risk of PPD. Findings may inform urban design policies and provide awareness for care providers on the association of patients’ residing neighborhoods and healthy pregnancy.
Appendix
Available only for authorised users
Literature
1.
2.
Chaiyachati KH, Hom JK, Hubbard RA, Wong C, Grande D. Evaluating the association between the built environment and primary care access for new Medicaid enrollees in an urban environment using Walk and Transit Scores. Prev Med Rep. 2018;9:24–8.PubMedCrossRef
3.
Beutel ME, Brahler E, Ernst M, Klein E, Reiner I, Wiltink J, et al. Noise annoyance predicts symptoms of depression, anxiety and sleep disturbance 5 years later. Findings from the Gutenberg Health Study. Eur J Public Health. 2020;30(3):516–21.PubMedCrossRef
4.
Galea S, Ahern J, Rudenstine S, Wallace Z, Vlahov D. Urban built environment and depression: a multilevel analysis. J Epidemiol Community Health. 2005;59(10):822–7.PubMedPubMedCentralCrossRef
5.
Emeruwa UN, Ona S, Shaman JL, Turitz A, Wright JD, Gyamfi-Bannerman C, Melamed A. Associations Between Built Environment, Neighborhood Socioeconomic Status, and SARS-CoV-2 Infection Among Pregnant Women in New York City. JAMA. 2020;324(4):390-2. https://​doi.​org/​10.​1001/​jama.​2020.​11370.
6.
Mullings JA, McCaw-Binns AM, Archer C, Wilks R. Gender differences in the effects of urban neighborhood on depressive symptoms in Jamaica. Revista Panamericana De Salud Publica-Pan American Journal of Public Health. 2013;34(6):385–92.
7.
Veldhuis CB, Maki P, Molina K. Psychological and neighborhood factors associated with urban women’s preventive care use. J Behav Med. 2020;43(3):346–64.PubMedCrossRef
8.
Guglielminotti J, Landau R, Wong CA, Li G. Patient-, Hospital-, and Neighborhood-Level Factors Associated with Severe Maternal Morbidity During Childbirth: A Cross-Sectional Study in New York State 2013–2014. Matern Child Health J. 2019;23(1):82–91.PubMedCrossRef
9.
McEachan RRC, Prady SL, Smith G, Fairley L, Cabieses B, Gidlow C, et al. The association between green space and depressive symptoms in pregnant women: moderating roles of socioeconomic status and physical activity. Journal of Epidemiology and Community Health. 2016;70(3):253–9.PubMedCrossRef
10.
11.
Glance LG, Dick AW, Glantz JC, Wissler RN, Qian F, Marroquin BM, et al. Rates Of Major Obstetrical Complications Vary Almost Fivefold Among US Hospitals. Health Affairs. 2014;33(8):1330–6.PubMedCrossRef
12.
Grobman WA, Bailit JL, Rice MM, Wapner RJ, Varner MW, Thorp JM, et al. Can differences in obstetric outcomes be explained by differences in the care provided? The MFMU Network APEX study. American Journal of Obstetrics and Gynecology. 2014;211(2).
13.
Farr SL, Dietz PM, Rizzo JH, Vesco KK, Callaghan WM, Bruce FC, et al. Health Care Utilisation in the First Year of Life Among Infants of Mothers With Perinatal Depression or Anxiety. Paediatric and Perinatal Epidemiology. 2013;27(1):81–8.PubMedPubMedCentralCrossRef
14.
Cunningham SD, Magriples U, Thomas JL, Kozhimannil KB, Herrera C, Barrette E, et al. Association Between Maternal Comorbidities and Emergency Department Use Among a National Sample of Commercially Insured Pregnant Women. Academic Emergency Medicine. 2017;24(8):940–7.PubMedCrossRef
15.
Kilfoyle KA, Vrees R, Raker CA, Matteson KA. Nonurgent and urgent emergency department use during pregnancy: an observational study. American journal of obstetrics and gynecology. 2017;216(2):181. e1-. e7.PubMedCrossRef
16.
D’Ascoli PT, Alexander GR, Petersen DJ, Kogan MD. Parental factors influencing patterns of prenatal care utilization. J Perinatol. 1997;17(4):283–7.PubMed
17.
Akaraci S, Feng XQ, Suesse T, Jalaludin B, Astell-Burt T. A Systematic Review and Meta-Analysis of Associations between Green and Blue Spaces and Birth Outcomes. International Journal of Environmental Research and Public Health. 2020;17(8).
18.
Niedzwiecki MM, Rosa MJ, Solano-Gonzalez M, Kloog I, Just AC, Martinez-Medina S, et al. Particulate air pollution exposure during pregnancy and postpartum depression symptoms in women in Mexico City. Environ Int. 2020;134:105325.PubMedCrossRef
19.
Sheffield PE, Speranza R, Chiu YM, Hsu HL, Curtin PC, Renzetti S, et al. Association between particulate air pollution exposure during pregnancy and postpartum maternal psychological functioning. PLoS One. 2018;13(4):e0195267.PubMedPubMedCentralCrossRef
20.
He S, Smargiassi A, Low N, Bilodeau-Bertrand M, Ayoub A, Auger N. Residential noise exposure and the longitudinal risk of hospitalization for depression after pregnancy: Postpartum and beyond. Environ Res. 2019;170:26–32.PubMedCrossRef
21.
Crockett K, Zlotnick C, Davis M, Payne N, Washington R. A depression preventive intervention for rural low-income African-American pregnant women at risk for postpartum depression. Arch Womens Ment Health. 2008;11(5–6):319–25.PubMedCrossRef
22.
Beeber LS, Holditch-Davis D, Belyea MJ, Funk SG, Canuso R. In-home intervention for depressive symptoms with low-income mothers of infants and toddlers in the United States. Health Care Women Int. 2004;25(6):561–80.PubMedCrossRef
23.
Giurgescu C, Zenk SN, Templin TN, Engeland CG, Dancy BL, Park CG, et al. The Impact of Neighborhood Environment, Social Support, and Avoidance Coping on Depressive Symptoms of Pregnant African-American Women. Womens Health Issues. 2015;25(3):294–302.PubMedPubMedCentralCrossRef
24.
Hahn-Holbrook J, Cornwell-Hinrichs T, Anaya I. Economic and Health Predictors of National Postpartum Depression Prevalence: A Systematic Review, Meta-analysis, and Meta-Regression of 291 Studies from 56 Countries. Front Psychiatry. 2017;8:248.PubMedCrossRef
25.
Jacques N, de Mola CL, Josephc G, Mesenburg MA, da Silveira MF. Prenatal and postnatal maternal depression and infant hospitalization and mortality in the first year of life: A systematic review and meta-analysis. Journal of Affective Disorders. 2019;243:201–8.PubMedCrossRef
26.
Weobong B, ten Asbroek AHA, Soremekun S, Gram L, Amenga-Etego S, Danso S, et al. Association between probable postnatal depression and increased infant mortality and morbidity: findings from the DON population-based cohort study in rural Ghana. Bmj Open. 2015;5(8).
27.
Field T. Postpartum depression effects on early interactions, parenting, and safety practices: A review. Infant Behavior & Development. 2010;33(1):1–6.CrossRef
28.
Stein A, Pearson RM, Goodman SH, Rapa E, Rahman A, McCallum M, et al. Effects of perinatal mental disorders on the fetus and child. Lancet. 2014;384(9956):1800–19.PubMedCrossRef
29.
Moore Simas TA, Huang MY, Packnett ER, Zimmerman NM, Moynihan M, Eldar-Lissai A. Matched cohort study of healthcare resource utilization and costs in young children of mothers with postpartum depression in the United States. J Med Econ. 2020;23(2):174–83.PubMedCrossRef
30.
Silverman ME, Reichenberg A, Savitz DA, Cnattingius S, Lichtenstein P, Hultman CM, et al. The risk factors for postpartum depression: A population-based study. Depress Anxiety. 2017;34(2):178–87.PubMedPubMedCentralCrossRef
31.
Howard LM, Molyneaux E, Dennis CL, Rochat T, Stein A, Milgrom J. Non-psychotic mental disorders in the perinatal period. Lancet. 2014;384(9956):1775–88.PubMedCrossRef
32.
Chen HL, Cai JY, Zha ML, Shen WQ. Prenatal smoking and postpartum depression: a meta-analysis. J Psychosom Obstet Gynaecol. 2019;40(2):97–105.PubMedCrossRef
33.
OHara MW, Swain AM. Rates and risk of postpartum depression - A meta-analysis. International Review of Psychiatry. 1996;8(1):37–54.CrossRef
34.
Zhang SM, Wang LS, Yang TB, Chen LZ, Qiu X, Wang TT, et al. Maternal violence experiences and risk of postpartum depression: A meta-analysis of cohort studies. European Psychiatry. 2019;55:90–101.PubMedCrossRef
35.
Norhayati MN, Hazlina NHN, Asrenee AR, Emilin WMAW. Magnitude and risk factors for postpartum symptoms: A literature review. Journal of Affective Disorders. 2015;175:34–52.PubMedCrossRef
36.
Feng XQ, Astell-Burt T. Residential green space quantity and quality and symptoms of psychological distress: a 15-year longitudinal study of 3897 women in postpartum. Bmc Psychiatry. 2018;18.
37.
He SY, Smargiassi A, Low N, Bilodeau-Bertrand M, Ayoub A, Auger N. Residential noise exposure and the longitudinal risk of hospitalization for depression after pregnancy: Postpartum and beyond. Environmental Research. 2019;170:26–32.PubMedCrossRef
38.
Schinasi LH, Auchincloss AH, Forrest CB, Roux AVD. Using electronic health record data for environmental and place based population health research: a systematic review. Annals of Epidemiology. 2018;28(7):493–502.PubMedCrossRef
39.
Zhang Y, Padman R, Patel N. Paving the COWpath: Learning and visualizing clinical pathways from electronic health record data. J Biomed Inform. 2015.
40.
Huber C. Introduction to Structural Equation Modeling Using Stata. California Association for Institutional Research. 2014.
41.
Odigie E, Lacson R, Raja A, Osterbur D, Ip I, Schneider L, et al. Fast Healthcare Interoperability Resources, Clinical Quality Language, and Systematized Nomenclature of Medicine-Clinical Terms in Representing Clinical Evidence Logic Statements for the Use of Imaging Procedures: Descriptive Study. JMIR Med Inform. 2019;7(2):e13590.PubMedPubMedCentralCrossRef
42.
Ronning M, Blix HS, Harbo BT, Strom H. Different versions of the anatomical therapeutic chemical classification system and the defined daily dose - are drug utilisation data comparable? European Journal of Clinical Pharmacology. 2000;56(9–10):723–7.PubMedCrossRef
43.
Frank LD, Engelke PO. The built environment and human activity patterns: exploring the impacts of urban form on public health. Journal of planning literature. 2001;16(2):202–18.CrossRef
44.
Jiang B, Liang S, Peng Z-R, Cong H, Levy M, Cheng Q, et al. Transport and public health in China: the road to a healthy future. The Lancet. 2017;390(10104):1781–91.CrossRef
45.
Pucher J, Buehler R, Bassett DR, Dannenberg AL. Walking and cycling to health: a comparative analysis of city, state, and international data. American journal of public health. 2010;100(10):1986–92.PubMedPubMedCentralCrossRef
46.
Besser LM, Dannenberg AL. Walking to public transit: steps to help meet physical activity recommendations. American journal of preventive medicine. 2005;29(4):273–80.PubMedCrossRef
47.
Berke EM, Koepsell TD, Moudon AV, Hoskins RE, Larson EB. Association of the built environment with physical activity and obesity in older persons. American journal of public health. 2007;97(3):486–92.PubMedPubMedCentralCrossRef
48.
49.
Vovsha P, Petersen E, Donnelly R. Microsimulation in travel demand modeling: Lessons learned from the New York best practice model. Transportation Research Record: Journal of the Transportation Research Board. 2002(1805):68–77.
50.
Pollution HEIPotHEoT-RA. Traffic-related air pollution: a critical review of the literature on emissions, exposure, and health effects: Health Effects Institute; 2010.
51.
Karner AA, Eisinger DS, Niemeier DA. Near-Roadway Air Quality: Synthesizing the Findings from Real-World Data. Environmental Science & Technology. 2010;44(14):5334–44.CrossRef
52.
Tayarani M, Poorfakhraei A, Nadafianshahamabadi R, Rowangould GM. Evaluating unintended outcomes of regional smart-growth strategies: Environmental justice and public health concerns. Transportation research part D: transport and environment. 2016;49:280 – 90.
53.
Frank LD, Sallis JF, Conway TL, Chapman JE, Saelens BE, Bachman W. Many pathways from land use to health: associations between neighborhood walkability and active transportation, body mass index, and air quality. Journal of the American planning Association. 2006;72(1):75–87.CrossRef
54.
Sugiyama T, Leslie E, Giles-Corti B, Owen N. Associations of neighbourhood greenness with physical and mental health: do walking, social coherence and local social interaction explain the relationships? Journal of Epidemiology and Community Health. 2008;62(5).
55.
Kim S-Y, Bechle M, Hankey S, Sheppard L, Szpiro A, Marshall J, editors. A Parsimonious Approach to National Prediction: Criteria Pollutants in the Contiguous US, 1979–2015. ISEE Conference Abstracts; 2018.
56.
Cantor MN, Chandras R, Pulgarin C. FACETS: using open data to measure community social determinants of health. Journal of the American Medical Informatics Association. 2017;0(0).
57.
Zhang Y, Padman R, Epner P, Bauer V, Solomonides A, Rao G. Identifying Diagnostic Paths for Undifferentiated Abdominal Pain from Electronic Health Record Data. AMIA Jt Summits Transl Sci Proc. 2018;2017:290-9.
58.
Movahedi F, Kormos RL, Lohmueller L, Seese L, Kanwar M, Murali S, et al. Sequential pattern mining of longitudinal adverse events after Left Ventricular Assist Device implant. IEEE J Biomed Health Inform. 2019.
59.
Wang S, Pathak J, Zhang Y. Using Electronic Health Records and Machine Learning to Predict Postpartum Depression. Studies in health technology and informatics. 2019;264:888 – 92.
60.
Zaki MJ. Spade: an efficient algorithm for mining frequent sequences. Mach Learn. 2001;42(1–2):31–60.CrossRef
61.
Azur MJ, Stuart EA, Frangakis C, Leaf PJ. Multiple imputation by chained equations: what is it and how does it work? International Journal of Methods in Psychiatric Research. 2011;20(1):40–9.PubMedPubMedCentralCrossRef
Metadata
Title
Identifying urban built environment factors in pregnancy care and maternal mental health outcomes
Authors
Yiye Zhang
Mohammad Tayarani
Shuojia Wang
Yifan Liu
Mohit Sharma
Rochelle Joly
Arindam RoyChoudhury
Alison Hermann
Oliver H. Gao
Jyotishman Pathak
Publication date
01-12-2021
Publisher
BioMed Central
Published in
BMC Pregnancy and Childbirth / Issue 1/2021
Electronic ISSN: 1471-2393
DOI
https://doi.org/10.1186/s12884-021-04056-1

Other articles of this Issue 1/2021

BMC Pregnancy and Childbirth 1/2021 Go to the issue

Research

Pregnant women’s decision-making capacity and adherence to iron supplementation in sub-Saharan Africa: a multi-country analysis of 25 countries

Research article

Current trends and geographical differences in therapeutic profile and outcomes of COVID-19 among pregnant women - a systematic review and meta-analysis

Research article

Predictive value of aberrant right subclavian artery for fetal chromosome aneuploidy in women of advanced maternal age

Research

Sleep quality in women with nausea and vomiting of pregnancy: a cross-sectional study

Research article

Prediction of labour onset in women who present with symptoms of preterm labour using cervical length

Research article

Maternal and neonatal outcomes in transverse and vertical skin incision for placenta previa