Author ORCID Identifier

Defense Date


Document Type


Degree Name

Doctor of Philosophy



First Advisor

Derek A. Chapman, PhD, MS

Second Advisor

Karen D. Hendricks-Muñoz, MD, MPH

Third Advisor

Robert A. Perera, PhD, MA

Fourth Advisor

Emily Zimmerman, PhD, MS, MPH


Introduction. Adverse perinatal outcomes can have lifelong and transgenerational consequences. Social determinants of health (SDOH) substantially influence these outcomes. Racism and neighborhood disadvantage are SDOH that have been independently linked to poor perinatal health.

Objectives. This research aimed to assess the joint effects of perceived racial discrimination (PRD) and perceived neighborhood safety (NS) on hypertensive disorders of pregnancy (HDP), low birthweight (LBW), preterm birth (PTB), and small-for-gestational age (SGA), and evaluate whether neighborhood deprivation mediates the relationship between racial residential segregation (RRS) and HDP.

Methods. Data from the Pregnancy Risk Assessment Monitoring System, Virginia birth certificates, and the Neighborhood Change Database were utilized. Multivariable logistic regression, principal component analysis, and multilevel structural equation modeling were employed.

Results. Neither PRD nor an unsafe neighborhood alone or in combination were associated with increased odds of HDP. The combined effect of PRD and an unsafe neighborhood were associated with increased odds of PTB, LBW, and SGA in unadjusted but not adjusted analyses. Exposure and outcome prevalence differed by race/ethnicity. RRS and neighborhood deprivation were associated with HDP in race-stratified analyses. Higher RRS was associated with increased HDP likelihood among non-Hispanic Black women and reduced HDP odds among non-Hispanic White women, with neighborhood deprivation mediating these relationships.

Conclusions. Racism and neighborhood context influence perinatal health. Results indicate that racial/ethnic disparities exist and that structural factors are important for perinatal outcomes. Continued investigation of these SDOH along with an inclusive approach for conceptualizing health disparities can inform intervention development and improve maternal and infant health.


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Available for download on Monday, May 10, 2027