Unemployment during the Great Recession and large-for-gestational age births

Abstract

Background Several studies have suggested that record high unemployment during the Great Recession was associated with deleterious changes in diet and weight-related health. However, studies have yet to explore whether the Great Recession was also associated with obesityrelated health in utero. Methods We investigated whether increasing county-level unemployment was associated with largefor-gestational age (LGA) births, using repeated cross-sectional data from California birth records between 2008 and 2011 (n = 1,715,052). LGA was defined as >90th percentile, using the Oken reference. We use the annual 1-year lagged value for county-level unemployment (2007-2010) and limit our analyses to singleton, term births. Linear probability models, with county and year fixed-effects were used to examine the unemployment-LGA association. All models control for county-level foreclosure rates, child gender, and maternal age, parity, education, and race/ethnicity. Results An increase in county-level unemployment was not statistically significantly associated with the prevalence of LGA (percentage point [PP]: 0.12; 95% CI:-0.02, 0.25). But, over the period of observation, for every one standard deviation increase in unemployment, LGA prevalence increased by 5% and p = 0.08. Conclusions These results cautiously suggest some deleterious effects of the Great Recession on obesity-related health in utero.