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The Birth and Beyond (BABY) study: protocol for a birth cohort study investigating the social and environmental determinants of pregnancy-related outcomes in Black American families
  1. Betty Lin1,2,
  2. Rachel R Middleton1,
  3. Bethlehem Terefe2,
  4. Allison A Appleton3,
  5. Beth J Feingold4,
  6. Tara Lynch2,
  7. Alex L Pieterse5,
  8. Rebecca Rogers2,
  9. Annabelle E Armah1,
  10. Lydia F Bierce1,
  11. Amanda M Flagg1,
  12. Sarah McCarthy6
  1. 1 Department of Psychology, College of Arts and Sciences, University at Albany, Albany, New York, USA
  2. 2 Obstetrics and Gynecology, Albany Medical Center, Albany, New York, USA
  3. 3 Department of Epidemiology and Biostatistics, School of Public Health, University at Albany, Albany, New York, USA
  4. 4 Department of Environmental Health Sciences, School of Public Health, University at Albany, Albany, New York, USA
  5. 5 Department of Counseling, Educational and Developmental Psychology, Boston College Carolyn A and Peter S Lynch School of Education and Human Development, Chestnut Hill, Massachusetts, USA
  6. 6 Department of Sociology, University at Albany College of Arts and Sciences, Albany, New York, USA
  1. Correspondence to Betty Lin; blin6{at}


Introduction In the USA, Black birthing people and infants experience disproportionately worse pregnancy-related health outcomes. The causes for these disparities are unknown, but evidence suggests that they are likely socially and environmentally based. Efforts to identify the determinants of these racial disparities are urgently needed to elucidate the highest priority targets for intervention. The Birth and Beyond (BABY) study evaluates how micro-level (eg, interpersonal and family) and macro-level (eg, neighbourhood and environmental) risk and resiliency factors transact to shape birth person-infant health, and underlying psychobiological mechanisms.

Methods and analysis The BABY study will follow 350 Black families (birthing parents, non-birthing parents and infants) from pregnancy through the first postpartum year, with research visits during pregnancy and at infant ages 6 and 12 months. Research visits comprise a combination of interview about a range of recent and life course stress and resiliency exposures and supports, psychophysiological (sympathetic, parasympathetic and adrenocortical) assessment and behavioural observations of parent–infant coregulatory behaviours. Spatial analyses are completed by mapping parent current and past residential addresses onto archival public data (eg, about neighbourhood quality and racial segregation). Finally, EMRs are abstracted for information about birthing parent relevant medical history, pregnancy conditions and infant birth outcomes. Analyses will evaluate the risk and resiliency mechanisms that contribute to pregnancy and birth-related outcomes for Black birthing people and their infants, and the protective role of individual, familial, cultural, and community supports.

Ethics and dissemination The BABY study has been approved by the Institutional Review Board at Albany Medical Centre. The study team consulted with local organisations and groups comprised of stakeholders and community leaders and continues to do so throughout the study. Research results will be disseminated with the scientific and local community as appropriate.

  • Pregnancy
  • Stress, Physiological
  • Health Equity

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  • X @AmandaMFlagg

  • Contributors BL contributed to initial conception and design of the study, and BL, AAA, BJF, ALP, TL and RR helped to refine the conceptualisation and design, secure funding and implement the study. RRM and BT helped coordinate study implementation. RRM, BT, AEA, AMF and LFB contributed to data collection and processing, and SM to data processing. BL, RRM and BT drafted this initial manuscript, and all authors have critically reviewed and approved the final version.

  • Funding This work is supported by NICHD R01HD106913. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health

  • Competing interests RR receives royalties from Uptodate.

  • Patient and public involvement Patients and/or the public were involved in the design, or conduct, or reporting or dissemination plans of this research. Refer to the Methods section for further details.

  • Provenance and peer review Not commissioned; peer reviewed for ethical and funding approval prior to submission.