In utero exposure to economic fluctuations and birth outcomes: An analysis of the relevance of the local unemployment rate in Brazilian state capitals

Autoři: Matias Mrejen aff001;  Danielle Carusi Machado aff001
Působiště autorů: Department of Economics, Universidade Federal Fluminense, Niterói, Rio de Janeiro, Brazil aff001
Vyšlo v časopise: PLoS ONE 14(10)
Kategorie: Research Article
doi: 10.1371/journal.pone.0223673



Analyze if in utero exposure to economic downturns is associated with worsened birth outcomes.


We used birth records from all live singleton births in the 27 Brazilian state capitals between October 2012 and December 2016 (n = 2,952,430) and linked them to local unemployment rates according to the mother’s residence. We estimated the association between different birth outcomes and the local unemployment rate in the three trimesters before birth. We included maternal characteristics and month, year and municipality fixed effects as covariates. We also estimated the association for different groups of mothers, based on marital status, educational level, age and race.


A 1 p.p. increase in the local unemployment rate in the trimester before birth is associated with 2.68% higher odds of being born with very low birthweight (< 1500 grams) (OR: 1.0268, 95% CI: 1.0006–1.0536). That result is pushed by the effect among newborns from mothers younger than 24 (OR: 1.0684, 95%CI: 1.0353–1.1024), from mothers with 11 years of schooling or less (OR: 1.0477, 95% CI: 1.0245–1.0714), and from brown or black mothers (OR: 1.0387, 95%CI: 1.0156–1.0624). The associations among children born from younger, less educated and black or brown mothers are robust to the application of a procedure to control for multiple testing, albeit the results considering the whole sample are not.


Our study shows that there is an association between in utero exposure to higher unemployment rates during the last gestational trimester and the odds of being born with VLBW among children born from mothers younger than 24 years old, with less of 11 years of education and black or brown. These results suggest that children born from women of low socioeconomic status are more vulnerable to in utero exposure to economic downturns.

Klíčová slova:

Brazil – Economics – Economics of training and education – Neonates – Pregnancy – Preterm birth – Urban areas – Unemployment rates


1. Kramer MS. Determinants of low birth weight: methodological assessment and meta-analysis. Bull World Health Org. 1987;65(5):663–737. 3322602

2. Almond D, Currie J. Killing Me Softly: The Fetal Origins Hypothesis. J Econ Perspect. 2011;25(3):153–72. doi: 10.1257/jep.25.3.153 25152565

3. Almond D, Currie J, Duque V. Childhood Circumstances and Adult Outcomes: Act II. J Econ Lit. 2018 Dec;56(4):1360–446. doi: 10.1257/jel.20171164

4. Almond D. Is the 1918 Influenza Pandemic Over? Long‐Term Effects of In Utero Influenza Exposure in the Post‐1940 U.S. Population. J Polit Econ. 2006 Aug;114(4):672–712. doi: 10.1086/507154

5. Brown R. The Mexican Drug War and Early-Life Health: The Impact of Violent Crime on Birth Outcomes. Demography. 2018 Feb;55(1):319–40. doi: 10.1007/s13524-017-0639-2 29344926

6. Currie J. Pollution and Infant Health. Child Dev Perspect. 2013 Dec;7(4):237–42. doi: 10.1111/cdep.12047 27134646

7. Torche F. The Effect of Maternal Stress on Birth Outcomes: Exploiting a Natural Experiment. Demography. 2011;48(4):1473–1491. doi: 10.1007/s13524-011-0054-z 21870187

8. Olafsson A. Household Financial Distress and Initial Endowments: Evidence from the 2008 Financial Crisis. Health Econ. 2016 Nov;25:43–56. doi: 10.1002/hec.3426 27870297

9. Margerison-Zilko CE, Li Y, Luo Z. Economic Conditions During Pregnancy and Adverse Birth Outcomes Among Singleton Live Births in the United States, 1990–2013. Am J Epidemiol. 2017 Nov 15;186(10):1131–9. doi: 10.1093/aje/kwx179 29036485

10. Bozzoli C, Quintana-Domeque C. The Weight of the Crisis: Evidence From Newborns in Argentina. Rev Econ Stat. 2014;96(3):550–562. doi: 10.1162/REST_a_00398

11. Wehby GL, Gimenez LG, López-Camelo JS. The impact of unemployment cycles on child and maternal health in Argentina. Int J Public Health. 2017 Mar;62(2):197–207. doi: 10.1007/s00038-016-0857-1 27572492

12. Noelke C, Chen Y-H, Osypuk TL, Acevedo-Garcia D. Economic Downturns and Inequities in Birth Outcomes: Evidence From 149 Million US Births. Am J Epidemiol. 2019 Jun 1;188(6):1092–100. doi: 10.1093/aje/kwz042 30989169

13. Dehejia R, Lleras-Muney A. Booms, Busts, and Babies’ Health. Q J Econ. 2004;119(3):1091–1130. doi: 10.1162/0033553041502216

14. Bhutta ZA, Darmstadt GL, Hasan BS, Haws RA. Community-Based Interventions for Improving Perinatal and Neonatal Health Outcomes in Developing Countries: A Review of the Evidence. Pediatrics. 2005 Feb;115(Supplement 2):519–617. doi: 10.1542/peds.2004-1441 15866863

15. Barker D. Adult Consequences of Fetal Growth Restriction. Clin Obstet Gynecol. 2006;49(2).

16. Figlio D, Guryan J, Karbownik K, Roth J. The Effects of Poor Neonatal Health on Children’s Cognitive Development. Am Econ Rev. 2014 Dec;104(12):3921–55. doi: 10.1257/aer.104.12.3921 29533575

17. Black SE, Devereux PJ, Salvanes KG. From the Cradle to the Labor Market? The Effect of Birth Weight on Adult Outcomes. Q J Econ. 2007 Feb 1;122(1):409–39. doi: 10.1162/qjec.122.1.409

18. Bruckner TA, Mortensen LH, Catalano RA. Spontaneous pregnancy loss in Denmark following economic downturns. Am J Epidemiol. 2016;183(8):701–708. doi: 10.1093/aje/kww003 27009344

19. Catalano R, Bruckner T, Anderson E, et al. Fetal death sex ratios: a test of the economic stress hypothesis. Int J Epidemiol. 2005;34(4):944–948. doi: 10.1093/ije/dyi081 15833788

20. Bruckner TA, Catalano R. Selection in utero and population health: Theory and typology of research. SSM Popul Health. 2018 Aug;5:101–13. doi: 10.1016/j.ssmph.2018.05.010 29928686

21. Margerison Zilko CE. Economic contraction and birth outcomes: an integrative review. Hum Reprod Update. 2010 Jul 1;16(4):445–58. doi: 10.1093/humupd/dmp059 20085917

22. Wadhwa PD, Garite TJ, Porto M, Glynn L, Chicz-DeMet A, Dunkel-Schetter C, et al. Placental corticotropin-releasing hormone (CRH), spontaneous preterm birth, and fetal growth restriction: A prospective investigation. Am J Obstet Gynecol. 2004 Oct;191(4):1063–9. doi: 10.1016/j.ajog.2004.06.070 15507922

23. Beijers R, Buitelaar JK, de Weerth C. Mechanisms underlying the effects of prenatal psychosocial stress on child outcomes: beyond the HPA axis. Eur Child Adolesc Psychiatry. 2014 Oct;23(10):943–56. doi: 10.1007/s00787-014-0566-3 24875898

24. Dunkel Schetter C. Psychological Science on Pregnancy: Stress Processes, Biopsychosocial Models, and Emerging Research Issues. Annu Rev Psychol. 2011 Jan 10;62(1):531–58. doi: 10.1146/annurev.psych.031809.130727 21126184

25. Abu-Saad K, Fraser D. Maternal Nutrition and Birth Outcomes. Epidemiol Rev. 2010 Apr 1;32(1):5–25. doi: 10.1093/epirev/mxq001 20237078

26. Stein AD, Lumey LH. The relationship between maternal and offspring birth weights after maternal prenatal famine exposure: the Dutch Famine Birth Cohort Study. Hum Biol. 2000 Aug;72(4):641–54.

27. Rocha R, Soares RR. Water scarcity and birth outcomes in the Brazilian semiarid. J Dev Econ. 2015;112:72–91.

28. Rasella D, Aquino R, Barreto ML. Impact of the Family Health Program on the quality of vital information and reduction of child unattended deaths in Brazil: an ecological longitudinal study. BMC Public Health. 2010 Dec;10(1). doi: 10.1186/1471-2458-10-380 20587036

29. Silveira MF, Victora CG, Horta BL, da Silva BGC, Matijasevich A, Barros FC, et al. Low birthweight and preterm birth: trends and inequalities in four population-based birth cohorts in Pelotas, Brazil, 1982–2015. Int J Epidemiol. 2019 Apr 1;48(Supplement_1):i46–53. doi: 10.1093/ije/dyy106 29939270

30. Foureaux Koppensteiner M, Manacorda M. Violence and Birth Outcomes: Evidence From Homicides in Brazil. J Dev Econ. 2016;119:16–33.

31. Villar J, Ismail LC, Victora CG, Ohuma EO, Bertino E, Altman DG, et al. International standards for newborn weight, length, and head circumference by gestational age and sex: the Newborn Cross-Sectional Study of the INTERGROWTH-21st Project. Lancet. 2014 Sep;384(9946):857–68. doi: 10.1016/S0140-6736(14)60932-6 25209487

32. Instituto Brasileiro de Geografia e Estatística–IBGE. Pesquisa Nacional por Amostra de Domicílios Contínua. Algumas características da força de trabalho por cor ou raça, [Internet]. Rio de Janeiro, 2017 Feb. Available from: (last accessed: 5 March 2019)

33. Bertrand M, Duflo E, Mullainathan S. How Much Should We Trust Differences-In-Differences Estimates? Q J Econ. 2004 Feb 1;119(1):249–75. doi: 10.1162/003355304772839588

34. Colin Cameron A, Miller DL. A Practitioner’s Guide to Cluster-Robust Inference. J Hum Resour. 2015;50(2):317–72. doi: 10.3368/jhr.50.2.317

35. Benjamini Y, Hochberg Y. Controlling the False Discovery Rate: A Practical and Powerful Approach to Multiple Testing. J R Stat Soc Series B Stat Methodol, 1995; 57(1): 289–300.

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