ABSTRACTBackground and Objectives: Preterm birth (PTB) contributes substantially to neonatal mortality, morbidity, and long-term neurological disabilities. While many potential risk factors for PTB have been extensively studied, workplace exposures and experiences during pregnancy have rarely been studied, especially among Black women. My dissertation aimed to 1) evaluate the associations between multiple dimensional work exposures (work hours, physical demands, psychological demands, job strain) and PTB, 2) determine if psychosocial factors (social support, depressive symptoms, stress) and lifetime experiences of racism moderate the associations. Methods: Using cohort data of Black women residing in Baltimore, we conducted a within-group analysis restricted to the 429 women employed during pregnancy. We used log-binomial regression analyses to determine the role of work exposures on PTB risk and to adjust for the potential covariates. We conducted moderation analyses on a multiplicative scale by adding an interaction term between the work exposure and the potential moderator to the adjusted regression models. We determined the significance of the interaction terms using the Likelihood Ratio (LR) chi-square test and a p-value less than 0.10. Results: Positive associations between PTB and prolonged working hours (aPR = 1.56; 95% CI: 0.75, 3.24), lifting heavy loads (aPR = 1.33; 95% CI: 0.88, 2.00). Working with physically awkward body positions was associated with lower PTB rates (aPR = 0.67; 95% CI: 0.43,1.07). Highest psychologically demanding work (top quartile vs. lower three quartiles) was significantly associated with PTB (aPR = 1.82; 95% CI: 1.20, 2.76). Modest PTB associations were observed with jobs that required an excessive amount of work (aPR=1.32; 95% CI: 0.84,2.07) or not having enough time to complete work (aPR=1.49; 95% CI: 0.92,2.42). We observed modest associations with PTB for women with high strain (aPR=1.47; 95% CI: 0.80,2.72), active (aPR=1.42; 95% CI: 0.76,2.66), and intermediate strain jobs (aPR=1.36; 95% CI: 0.81,2.27). Women enrolled postpartum had elevated PTB rates when working longer hours (aPR= 2.65; 95%CI: 1.00,7.01). Evidence of moderation by psychosocial factors for the PTB work exposure associations. High physically demanding work was associated with high PTB rates among women with low social support (aPR:1.90; 95% CI: 0.94,3.85). High psychologically demanding work was significantly associated with increased PTB rates among women with low social support (aPR: 1.92; 95% CI: 1.16, 3.17) and high depressive symptoms (aPR: 1.99; 95% CI: 1.12, 3.52). Among women with low social support, active (aPR: 2.47; 95% CI:1.12,5.44), high strain jobs (aPR: 2.05; 95% CI:0.93,4.53) were associated with increased PTB rates. Among women with high depressive symptoms, active (aPR: 3.10; 95% CI:1.07,8.98) and high strain jobs (aPR: 3.59; 95% CI:1.28,10.05) and passive jobs (aPR: 2.32; 95% CI:0.78,6.89) were associated with increased PTB rates. Conclusion: Physically demanding work activities may increase PTB rates in Black women, with evidence of interactions with social support. Black women with psychologically demanding work activities are at elevated risk of PTB, with evidence of interactions with psychosocial factors. PTB rates were elevated for women with active and high strain jobs after considering psychosocial factors. Evidence of interactions between the work exposures and psychosocial factors suggests that impacts are intertwined. Findings underscore the importance of implementing policies and measures that foster a supportive work environment for pregnant women to ensure better pregnancy outcomes.
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