From the aDepartment of Obstetrics, Gynecology and Reproductive Sciences, and Department of Medicine, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ

bDepartment of Biostatistics and Epidemiology, Rutgers School of Public Health, Piscataway, NJ

cCardiovascular Institute of New Jersey, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ

dEnvironmental and Occupational Health Sciences Institute (EOHSI), Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ

eDepartment of Data Analysis, Ghent University, Gent, Belgium.

Editor’s Note: A related article appears on p. 864–867.

Submitted May 3, 2021; accepted June 17, 2022

C.V.A. is partially supported by grants from the National Heart, Lung, and Blood Institute (R01-HL150065) and the National Institute for Environmental Health Sciences (R01-ES033190) of the National Institutes of Health. W.W.L. was supported by the Special Research Fund (BOF) of Ghent University postdoctoral fellowship BOF.PDO.2020.0045.01.

The data used in this study are publicly available at https://www.cdc.gov/nchs/data_access/vitalstatsonline.htm. The R scripts implementing the estimation procedure are available online at https://github.com/wwloh/perinatal-multiple-mediation.

The authors report no conflicts of interest.

Supplemental digital content is available through direct URL citations in the HTML and PDF versions of this article (www.epidem.com).

Correspondence: Cande V. Ananth, Division of Epidemiology and Biostatistics, Department of Obstetrics, Gynecology and Reproductive Sciences, Rutgers University, Robert Wood Johnson Medical School, 125 Paterson Street, New Brunswick, NJ 08901. E-mail: [email protected].