Background and objectives: Black infants in the United States experience disproportionately higher rates of fetal growth restriction (FGR) at birth (i.e., reduced birth weight relative to gestational age) than White infants, and infants of other racial/ethnic groups. FGR at birth is a leading cause of infant morbidity and mortality. The racial disparity in FGR is not fully explained by maternal morbidity (e.g., hypertension), socio-economic factors, or adequacy of prenatal care. The direct effect of paternal factors on FGR generally has been explored, but little attention has been given to how these factors intersect with maternal factors to influence FGR. Studies linking mother-father relationships to FGR have broadly focused on low birthweight (LBW; <2,500 grams). Findings have shown that pregnant women whose partners are involved in their lives are less likely to have a LBW baby. However, LBW is heterogenous and can include both FGR and preterm birth (PTB); the pathways to both outcomes also differ and should be assessed distinctly. The mother-father relationship context in Black families has not been reported in the literature on FGR. Evidence supporting the hypothesized pathways by which the mother-father relationship may impact FGR has, however, been reported. A growing number of publications report that depression and depressive symptoms increase risk of FGR with several papers including Black women or exclusive to Black women. Further, while such work is not extensive, reports do link the mother-father relationship, measured in divergent ways, to depression and depressive symptoms in pregnancy among all women as well as in Black women. Another hypothesized pathway is via marital/cohabitation status. Some studies report higher risks of a LBW infant among unmarried or non-cohabiting women, but studies focusing on FGR either exclusively in Black births or in a cohort of Black births are rare. Thus, the objectives of this dissertation are to 1) determine how measures of mother-father relationship (e.g., conflict, support, involvement) relate to FGR in Black infants, 2) determine if the associations between mother-father relationship and FGR are mediated by maternal depressive symptoms, and 3) determine if marital/cohabitation status moderates the association between mother-father relationship and FGR. Methods: Data from the Biosocial Impacts on Black Births (BIBB) prospective cohort study were used. Participants completed questionnaires at 19-29 weeks’ gestation including six measures of woman’s relationship with the FOB: 1) contact with FOB, 2) FOB involvement, 3) overall relationship, 4) change in relationship prior to pregnancy to during pregnancy, 5) social support from FOB, and 6) conflict with FOB. Latent class analysis was used to identify and classify the relationship construct. To address aim 1, we fit a multivariate logistic regression model using the relationship construct created to assess its association with FGR. For aim 2, we conducted mediation analysis, based on the potential outcomes’ framework, and for aim 3, we used the same multivariate regression model in aim 1, and included an interaction term to test for moderation by marital/cohabitation status. Results: we found that 1) the mother-father relationship construct can be classified as good, conflictual and no relationship, and women in the conflictual and no relationship groups have higher odds of having a growth restricted infant compared to those in good relationship, 2) there was no evidence of mediation by maternal depressive symptoms, and 3) marital/cohabitation status did not moderate the association between the mother-father relationship construct and FGR. Conclusion: The findings reported provide evidence suggesting that the mother-father relationship is an important correlate of fetal growth restriction in Black families. More work is needed to explore pathways by which this association occurs.
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