Inlay

Neonatal health in the United States serves as a sensitive reflection of the nation’s evolving social and environmental landscape-a barometer and consequence of broader systemic conditions.1 From the economic shocks of the 1930s to present-day challenges of persistent inequality and environmental degradation, external stressors have continuously shaped the earliest stages of life, compromising a period of profound developmental plasticity. Environmental and social adversity can become biologically embedded, influencing physiological trajectories across the lifespan2,3 as proposed by the Developmental Origins of Health and Diseases (DOHaD) framework. Mounting evidence indicates that adverse exposures such as extreme weather, neighborhood poverty, chronic psychological stress, proximity to pollutants, and limited access to green spaces have been associated with disruption of fetal development through stress-mediated pathways, including maternal hypothalamic-pituitary-adrenal (HPA) axis activation and downstream epigenetic changes.4 The legacy of discriminatory policies such as redlining, compounded by ongoing zoning practices and environmental injustice, has been associated with disparities in neonatal outcomes, contributing to disproportionate burdens of morbidity and mortality within marginalized communities.5 In addition to these psychological and environmental factors, disparities in prenatal care access, nutritional status, and infection risk are important pathways through which social and structural conditions may affect fetal growth, preterm birth, and small-for-gestational-age...