Pregnancy Outcomes Related to Food and Environmental Factors

This project will examine the associations between geographical factors with maternal health and pregnancy outcomes, with an emphasis on rural health. This project will also assess the risk of benzoic acid in pregnant women. Results of this study will provide differential risk factors for pregnancy outcomes in urban and rural communities in Michigan. The results will provide an understanding of the importance of access to year-round supply of fresh vegetables and fruits for optimum pregnancy outcomes. The project will also provide a health risk assessment of benzoic acid for pregnant women. In the past 30 years, the overall infant mortality rate (IMR) in the US decreased from greater than 15.0 per 1000 birth to the current 6.1 per 1000 in 2010. However, infant mortality rate in the United States continues to lag behind other wealthy countries. A newborn in the U.S. is 2.7 times as likely to die during the first year than one born in Finland and Japan, where the IMRs are 2.3 per 1000. Compared to the IMRs of infants born in Portugal (2.5 per 1000), Czech Republic, (2.7 per 1000), and Norway, (2.8 per 1000), US babies are more than twice as likely to die in the first year of their lives. While the elevated infant mortality rates in the U.S. are mostly associated with low education populations in the country, educational level alone does not explain the extraordinarily high IMRs, because over 85% of the adult population in the U.S. have completed high school, while less than 20% Portuguese have attained the same level of education. Furthermore, in the U.S., infant mortality rates remain 0.7 -1.3 per 1000 higher in rural areas than urban areas. This project will examine the associations between geographical factors with maternal health and pregnancy outcomes, which include low birth weight, preterm birth, birth defects, and infant mortality, with a focus on Michigan rural health. The main geographical factor will be accessibility to retail stores and markets for fresh fruits and vegetables. The pregnancy outcomes to be analyzed will include birth weight, birth defects, and infant survival, from 2000-2014, using Michigan birth data. The studies are designed based on the working hypothesis that food behavior and rural environmental and geographical factors can affect pregnancy outcomes independently or by interacting with maternal socioeconomic factors on pregnancy outcomes. The geographical and socioeconomic factors examined in the studies will include accessibility to fresh fruits and vegetables, educational levels, marital status, household income, type of health insurance, and accessibility and driving distance to health care facilities. To examine the effect of lack of access to year-round fresh vegetables and fruits, we will also conduct risk assessment for food preservatives that could affect directly the body's detoxification capability or indirectly affect neurotransmission in the nervous system, such as the effect of benzoic acid on glycine. This part of the project is designed based on the working hypothesis that distances to markets for fresh fruits and vegetables influence family food behavior, and the lack of year-round accessibility to fresh fruits and vegetables, in turn, is a risk factor for maternal obesity and associated poor pregnancy outcomes. Distance traveled to markets for fresh fruits and vegetables will be examined as the main risk factor for maternal obesity and undesirable pregnancy outcomes. Other known risk factors for maternal health and infant mortality will be examined as co-factors in the analyses.