Living in a disadvantaged neighborhood linked to reduced fecundability

The socioeconomic environment of a neighborhood may influence the ability to become pregnant, according to researchers.

Mary Willis, PhD, MPH, a postdoctoral scholar at Oregon State University, and colleagues reported that “a disadvantaged neighborhood environment was associated with a modest decrease in fecundability in the most disadvantaged areas.” Their findings were published in JAMA Network Open.

“Our findings underscore the importance of understanding the association between a disadvantaged neighborhood environment and reproductive health,” they wrote. “If confirmed in other studies, our results suggest that policies and programs that address socioeconomic inequities may reduce infertility in local communities.”

The researchers analyzed baseline data from 6,356 women aged 21 to 45 years who participated in the Pregnancy Study Online — an online cohort study of couples who were attempting spontaneous conception — from June 2013 to April 2019. They then used the Area Deprivation Index (ADI) — a tool that ranks neighborhoods by socioeconomic disadvantage based on factors such as housing quality, education, employment and more — to approximate “limitations of neighborhood disadvantage.”

The researchers reported that 83.3% of participants were white and 72.5% had at least 16 years of education. Those who lived in disadvantaged neighborhoods were less likely to be white (76.5%) and reported lower household incomes (less than $50,000; 41.6%), lower educational attainment (less than 12 years; 51.4%), younger ages (mean, 28.9 years) and that they were more likely to smoke (18.3%).

Overall, the researchers observed 3,725 pregnancies. When the top and bottom deciles of disadvantaged neighborhood status were compared, the adjusted fecundability ratios were 0.77 (95% CI, 0.65-0.92) for within-state ADI rankings and 0.79 (95% CI, 0.66-0.96) for national-level ADI rankings. The associations were “slightly stronger” for participants with annual incomes under $50,000.

Willis and colleagues noted that the associations between ADI and fecundity “were similar when neighborhood disadvantage was measured relative to the nation or the state,” lending support for “the hypothesis that local context may be particularly influential in fertility.”

The researchers were careful to evaluate neighborhood context — a “complex phenomenon” encompassing “a variety of chronic stress exposure pathways” — writing that public policies that influence decisions about neighborhood investments and disinvestments such as redlining “may perpetuate a cycle of chronic stress and continued neighborhood socioeconomic disadvantage.” For example, high unemployment rates in neighborhoods have been associated with decreased population-level fertility rates, and poorer areas often have higher concentrations of air pollution — another factor connected to adverse fertility outcomes.

Willis and colleagues concluded that more “investments in disadvantaged neighborhoods may yield positive cobenefits for fertility.”