The immigrant birthweight paradox in an urban cohort: Role of immigrant enclaves and ambient air pollution

My Dzung T. Chu, Harvard T.H. Chan School of Public Health
Stephanie Ettinger de Cuba, Boston University School of Medicine
M. Patricia Fabian, School of Public Health
Kevin James Lane, School of Public Health
Tamarra James-Todd, Harvard T.H. Chan School of Public Health
David R. Williams, Harvard T.H. Chan School of Public Health
Brent A. Coull, Harvard T.H. Chan School of Public Health
Fei Carnes, School of Public Health
Marisa Massaro, School of Public Health
Jonathan I. Levy, School of Public Health
Francine Laden, Harvard T.H. Chan School of Public Health
Megan Sandel, Boston University School of Medicine
Gary Adamkiewicz, Harvard T.H. Chan School of Public Health
Antonella Zanobetti, Harvard T.H. Chan School of Public Health


Background: Foreign-born Black and Latina women on average have higher birthweight infants than their US-born counterparts, despite generally worse socioeconomic indicators and prenatal care access, i.e., “immigrant birthweight paradox” (IBP). Residence in immigrant enclaves and associated social-cultural and economic benefits may be drivers of IBP. Yet, enclaves have been found to have higher air pollution, a risk factor for lower birthweight. Objective: We investigated the association of immigrant enclaves and children’s birthweight accounting for prenatal ambient air pollution exposure. Methods: In the Boston-based Children’s HealthWatch cohort of mother-child dyads, we obtained birthweight-for-gestational-age z-scores (BWGAZ) for US-born births, 2006–2015. We developed an immigrant enclave score based on census-tract percentages of foreign-born, non-citizen, and linguistically-isolated households statewide. We estimated trimester-specific PM2.5 concentrations and proximity to major roads based residential address at birth. We fit multivariable linear regressions of BWGAZ and examined effect modification by maternal nativity. Analyses were restricted to nonsmoking women and term births. Results: Foreign-born women had children with 0.176 (95% CI: 0.092, 0.261) higher BWGAZ than US-born women, demonstrating the IBP in our cohort. Immigrant enclave score was not associated with BWGAZ, even after adjusting for air pollution exposures. However, this association was significantly modified by maternal nativity (pinteraction = 0.014), in which immigrant enclave score was positively associated with BWGAZ for only foreign-born women (0.090, 95% CI: 0.007, 0.172). Proximity to major roads was negatively associated with BWGAZ (−0.018 per 10 m, 95% CI: −0.032, −0.003) and positively correlated with immigrant enclave scores. Trimester-specific PM2.5 concentrations were not associated with BWGAZ. Significance: Residence in immigrant enclaves was associated with higher birthweight children for foreign-born women, supporting the role of immigrant enclaves in the IBP. Future research of the IBP should account for immigrant enclaves and assess their spatial correlation with potential environmental risk factors and protective resources.