A leading Chicago scientist has received a March of Dimes Discovery Grant to pursue a decade plus long research interest to determine whether African Americans’ epigenetic risk for adverse birth outcomes stemming from early-life residence in impoverished urban neighborhoods can be reversed after two generations of upward economic mobility.
The work, by neonatologist Dr. James Collins, represents the first three-generational study of adverse birth outcomes in the field, and adds more evidence to the importance of helping women move out of impoverished neighborhoods to decrease racial disparities in adverse birth outcomes.
“We hypothesize that African American infant’s increased risk of adverse birth outcome reflects their mother’s inheritance of epigenetic factors resulting from their maternal grandmother’s impoverishment,” Dr. Collins said of his work.
Dr. Collins, who was one of three recipients of the 2024 March of Dimes Discovery Research Grant, has been focused on research into racial disparities in pregnancy and birth outcomes for more than 25 years.
In addition to his role as a full-time neonatologist working with high-risk and preterm babies, Dr. Collins is behind the first successful attempt to study three generations of African American women in the same families in order to understand how early-life residence in impoverished neighborhoods can lead to inheritable epigenetic changes that cause adverse birth outcomes passed down from moms to their daughters.
The word “epigenetics” means “in addition to” or “on top of” genetics and describes changes that may occur in cells and organisms in response to external cues in the environment. While our genetic code is the blueprint of our bodies, epigenetics refers to the mechanisms by which gene expression is activated or suppressed based on regulatory influences, which may include environmental factors such as stress, income level, smoking, diet, pollutants, and more. Importantly, these changes in gene expression, once they occur, can be passed on to future generations. Equally as important, they can also be reverted back to their original state, also in response to environmental cues.
Previous findings by Dr. Collins’ group have suggested that neighborhood poverty has an epigenetic effect on birth outcomes: namely, the stress related to being born in impoverished neighborhoods can cause changes in the expression of genes that make a baby more likely to be born with a low birth weight, and more likely, if that baby is a girl, to have a baby with adverse birth outcomes, such as prematurity, low birth weight, or small for gestational age.
In addition, Dr. Collins has also found that for women with this epigenetic risk (not all women born under the same conditions will have it), moving out of neighborhood poverty will not immediately reverse the risk. In other words, if a woman was born in an impoverished neighborhood and with a low birth weight (meaning she carries the risk), she’s more likely to have a baby born preterm, with low birth weight, or small for gestational age, even if she was no longer living in an impoverished neighborhood at the time of becoming pregnant and giving birth.
Now, Dr. Collins’ ongoing work aims to determine if this risk can be reversed after two generations of upward economic mobility. If so, this would mean that the daughters of women with the epigenetic risk would likely have babies without adverse outcomes if they were no longer living in impoverished neighborhoods.
This finding, that neighborhood poverty is a strong social determinant of perinatal health, adds weight to the argument that being able to move out of impoverished areas, and diminish the stress associated with living in those environments, leads to better birth outcomes.
It also helps explain the drastic disparity in birth outcomes between African American and White women—even though Dr. Collins admits this epigenetic risk likely exists with all women who experience poverty, regardless of race. But because a greater proportion of African American women live in impoverished neighborhoods compared with White women in the US, the neighborhood poverty-related epigenetic risk plays an outsized role in explaining the disparity in birth outcomes between the races.
“For example,” Dr. Collins said, “in Chicago, nearly 80% of [African Americans] live in impoverished neighborhood [versus] 2% of Whites; conversely, only 2% of [African Americans] live in affluent areas [versus] 80% of Whites.”
“Importantly, while I believe [the epigenetic mechanism] contributes to the racial disparity, I would be stunned if it singularly explained it.”
The exact mechanism of the risk—exactly how neighborhood poverty-related stress affects biological processes inside the body to cause this epigenetic change—is still unknown, Dr. Collins said. Both small and large stressors related to neighborhood poverty contribute to it, and they all add up.
“The data on stress suggests both acute and chronic stressors are important,” he said. “And cumulative. Each of them has negative impacts.”
Dr. Collins’ research team recently constructed a rare three-generation dataset of computerized birth records and neighborhood income information. This dataset of about 40,000 births in each generation will allow him to examine the relationship between African American and White women’s birth outcomes, economic mobility within and across the generations, and the risk of adverse birth outcome in their grandchildren.
March of Dimes Discovery Research Grants are $200,000 grants over a two-year period. They are given annually to established scientists to conduct translational research into three thematic areas: racial inequities as they relate to morbidity, mortality and access to care; spontaneous preterm birth; and heart conditions developed or exacerbated during pregnancy.
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