Multi-level factors influencing maternal and infant health outcomes

Maternal and infant health outcomes in the U.S. are notoriously poor compared to other high-income nations. Within the US, outcomes vary widely across states, with some states (e.g., Mississippi) having infant and maternal mortality rates more than twice the national average. Understanding the structural factors (i.e., legal, social, and economic contexts) that lead to worse maternal and infant health across US states is critical to reducing maternal and infant health inequities. Additionally, understanding the role of established perinatal risk factors (such as pregnancy intentions, prenatal care, intimate partner violence, and social and economic stressors) in pathways connecting contexts to health is imperative. Finally, because Black and other racial/ethnic groups experience much higher rates of maternal and infant morbidity and mortality relative to white women, it is vital to examine whether the associations between context and health are more pronounced among these groups. This study will directly address these gaps and innovate upon extant research by: 1) developing the most comprehensive and robust set of state-level context measures to date and making them publicly-available to accelerate the pace of scientific research, 2) conducting the first detailed analysis of the relationship between state-level structural factors and a wide range of maternal and infant health outcomes while adjusting for a variety of other individual covariates 3) investigating the mediating role of established perinatal risk factors, and 4) determining whether the relationship between structural factors and maternal and infant health varies by mothers’ race/ethnicity. To accomplish these objectives, we will leverage 20 years of data from the CDC’s Pregnancy Risk and Monitoring Study (PRAMS) (N= 765,809) births across 45 states over 20 years) to examine the relationship between structural factors and maternal infant health both across states and within states as they change over time. This study directly addresses the National Institute of Child Health and Human Development’s goal of identifying structural factors shaping maternal health and health care. The results of this study have the potential to substantially advance knowledge of understudied structural determinants of health and to generate critical insights for the development of future strategies to improve maternal and infant health. Project Number: 1R01HD117732-01 | Fiscal Year: 2026 | NIH Institute/Center: Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) | Principal Investigator: Patricia Homan | Institution: FLORIDA STATE UNIVERSITY, TALLAHASSEE, FL | Award Amount: $540,915 | Activity Code: R01 | Study Section: Reproductive, Perinatal and Pediatric Health Study Section[RPPH] View on NIH RePORTER: https://reporter.nih.gov/project-details/1R01HD11773201