Disparities In Low Birth Weight Research Articles

Racial Disparities in Low Birthweight Risk: an Examination of Stress Predictors.

This paper describes racial disparities in low birthweight (LBW) risk between Black women and White women and examines the relationship between race and stressors such as socioeconomic factors, access to health care, and social and health characteristics. We analyzed data from the National Survey of Family Growth dataset collected in the USA between 2006 and 2010 (N = 1516). Multivariate logistic regression models were performed. Prevalence of LBW was 5.6% for pregnancies among White women and 12.2% among Black women. Black women who had a LBW baby had a lower socioeconomic status (e.g., received assistance to pay for delivery of the baby and public assistance in the prior year). Black women who had a LBW baby were more likely to have reported having good health compared with White women (67.8 vs. 45.1%, p < .10). Pregnancies of Black women were 2.6 times more likely (odds ratio (OR) = 2.33; 95% confidence interval (CI), 1.12-6.04) to result in a LBW baby than pregnancies among White women. Pregnancies of women in the income group of 300% or higher than the poverty level were less likely to be associated with a LBW baby than those among women in the 150-299% income group (p < .10). Obese women were less likely to have LBW children than those who were underweight or normal weight (p < .10). Among pregnancies of White mothers (n = 943), the only significant variable was self-reported health status. White women who reported having poorer health were 3.7 times more likely to have LBW than those who reported having better health (p < .10). Among Black mothers, the only predictor that was negatively associated with an increased likelihood of having a LBW baby was the SES stressor related to receiving public assistance. Racial differences between Black and White women were observed in LBW risk based on socioeconomic factors. We analyzed a large number of stressors, but racial differences remained even after taking these stressors into account. Future policies and research should continually address these differences to decrease LBW risk within and across racial groups.

Community Level Correlates of Low Birthweight Among African American, Hispanic and White Women in California.

Racial and ethnic groups in the US exhibit major differences in low birthweight (LBW) rates. While previous studies have shown that community level social indicators associated with LBW vary by race and ethnicity, it is not known whether these differences exist among racial or ethnic groups who live in the same neighborhood or community. To address this question, we examined the association of community level features with LBW among African American, White and Hispanic women who live in similar geographic areas. The analysis is based on geocoded birth certificates for all singleton live births in the year 2000 to women residing in 805 California ZIP codes. Community level social and demographic data were obtained from U.S. Census data files for the year 2000 and surrogate indices of population level alcohol and drug abuse and dependence were derived from hospital discharge data (HDD). Tobit and bootstrap analyses were used to test associations with birth outcomes, maternal characteristics, and community level social and demographic features within and across the three groups of women living in similar geographic areas. The results demonstrate major racial and ethnic differences in community level correlates of LBW. Rates of LBW among African Americans were lower if they lived in areas that were more densely populated, had greater income disparities, were more racially segregated, and had low rates of alcohol abuse or dependence. These associations were different or absent for Hispanic and White women. The results suggest that despite living in the same areas, major differences in neighborhood features and social processes are linked to birth outcomes of African American women compared to Hispanic and White women. Further research, especially using multilevel approaches, is needed to precisely identify these differences to help reduce racial and ethnic disparities in LBW.

Association Between Life Event Stressors and Low Birth Weight in African American and White Populations: Findings from the 2007 and 2010 Los Angeles Mommy and Baby (LAMB) Surveys.

We examined the association between life events stressors during pregnancy and low birth weight (LBW) among African Americans and Whites, while systematically controlling for potential confounders including individual characteristics and city-level variations and clustering. We analyzed data from 4970 women with singleton births who participated in the 2007 and 2010 Los Angeles Mommy and Baby Surveys. Multilevel logistic regression was used to assess the association between emotional, financial, spousal and traumatic stressors and LBW among African Americans and Whites. Potential confounders included were: the city-level Economic Hardship Index, maternal demographics, pre-pregnancy conditions, insurance, behavioral risk factors and social support. African Americans were significantly more likely to experience any domain of stressors during their pregnancy, compared to Whites (p < 0.001). Only the association between financial stressors and LBW was significantly different between African Americans and Whites (p for interaction = 0.015). Experience of financial stressors during pregnancy was significantly associated with LBW among African Americans (adjusted odds ratio = 1.49; 95 % confidence interval = 1.01-2.22) but not Whites. Differential impact of financial stressors during pregnancy may contribute to racial disparities in LBW between African Americans and Whites. We showed that financial life event stressors, but not other domains of stressors, were more likely to impact LBW among African Americans than Whites. Initiatives aimed at mitigating the negative impacts of financial stress during pregnancy may contribute to reducing disparities in birth outcomes between African Americans and Whites.

Role of stress in low birthweight disparities between black and white women: a population-based study.

This study examines the role of stress in low birthweight (LBW) risk in Black and White women in the United States. Data from the 1998-2000 Fragile Family and Child Wellbeing Study were used (n = 3869). We included several self-reported conditions which we categorised as stressors (i.e. socio-economic conditions, health behaviours, access to quality care and cultural factors), then we used logistic regression models to analyse the role of stressors in explaining the health disparities in LBW. Most women were unmarried (59% for White women and 87% for Black women). Among unmarried White women, the only stressor associated with a higher likelihood of LBW was smoking (odds ratio (OR) = 2.0, 95% confidence interval (CI) (1.2, 3.3)). Among unmarried Black women, smoking (OR = 1.7, 95% CI (1.2, 2.3)), drug use (OR = 1.7, 95% CI (1.0, 2.6)), paying for the baby's birth with government resources (OR = 1.6, 95% CI (1.1, 2.4)) and religious affiliation (OR = 1.6, 95% CI (1.0, 2.5)) were associated with higher likelihood of LBW. Among married White women, older age (OR = 1.1, 95% CI (1.0, 1.2)), smoking (OR = 5.2, 95% CI (1.7, 15.5)), using governmental resources to pay for birth (OR = 3.6, 95% CI (1.0, 12.4)) and living in governmental housing (OR = 9.1, 95% CI (2.0, 41.1)) were associated with higher likelihood of LBW. No stressors were statistically significant for married Black women. We analysed a large number of stressors at the individual, household and societal levels and found differences on the stressors among Black and White women. However, the stressors included in the analyses did not fully explain the racial disparities in LBW.

Using a life course model to examine racial disparities in low birth weight during adolescence and young adulthood.

This study examined relationships between health, social, environmental, and economic factors during adolescence and the subsequent risk of giving birth to a low-birth-weight (LBW) infant, to inform strategies for reducing racial disparities in LBW. Data were derived from the National Longitudinal Study of Adolescent Health. A sample of 1213 adolescents, reporting on first pregnancies, was created with 35% black, non-Hispanic (black) and 65% white, non-Hispanic (white) participants. Independent variables were from the domains of individual characteristics, health status, access to care, and social environment. The dependent variable was low birth weight. Overall and race-specific logistic regression models were estimated. Black women had 1.9times the odds of giving birth to an LBW infant as white women. Factors associated with LBW differed between black women and white women. Black women with a history of hypertension were 6 times more likely to have an LBW infant. Intimate partner support during prenatal care was protective for black women. Factors associated with an increased risk of giving birth to an LBW infant for white women included an intergenerational pattern of LBW, low body mass index during adolescence, and smoking during pregnancy. Socioeconomic factors during adolescence did not predict the odds of having an LBW infant for either group, except for white women whose parents had less than a high school education and black women living in medium-poverty neighborhoods. Findings suggest that strategies to reduce racial disparities should address the specific needs of the population being served over the life course.

Selected Preconception Health Indicators and Birth Weight Disparities in a National Study

BackgroundThis analysis explored the effect of timing, sequencing, and change in preconception health across adolescence and young adulthood on racial/ethnic disparities in birth weight in a diverse national cohort of young adult women. MethodsData came from Waves I (1994–1995), III (2001–2002), and IV (2007–2008) of the National Longitudinal Study of Adolescent Health. Eligibility was restricted to all singleton live births to female non-Hispanic White, non-Hispanic Black, Mexican-origin Latina, or Asian/Pacific Islander participants (n = 3,014) occurring between the Wave III (ages 18–26 years) and IV (ages 24–32 years) interviews. Birth weight was categorized into low (<2,500 g), normal (2,500–4,000 g), and macrosomic (>4,000 g). Preconception health indicators were cigarette smoking, heavy alcohol consumption, overweight or obesity, and inadequate physical activity, measured in adolescence (Wave I, ages 11–19 years) and early adulthood (Wave III) and combined into four-category variables to capture the timing and sequencing of exposure. FindingsMeasures of preconception health did not explain the Black–White disparity in low birth weight, which increased after adjustment for confounders (odds ratio [OR], 2.17; 95% confidence interval [CI], 1.33–3.53) and effect modification by overweight/obesity (OR, 3.58; 95% CI, 1.65–7.78). A positive association between adult-onset overweight/obesity and macrosomia was modified by race (OR, 3.83; 95% CI, 1.02–14.36 for Black women). ConclusionsThis longitudinal analysis provides new evidence on preconception health and racial/ethnic disparities in birth weight. Specifically, it indicates that interventions focused on prevention of overweight/obesity and maintenance of healthy weight during the transition to adulthood, especially among Black females, may be warranted.

Young maternal age and low birth weight risk: An exploration of racial/ethnic disparities in the birth outcomes of mothers in the United States

This study considers how low birth weight (LBW) prevalence varies by race/ethnicity and maternal age and explores mechanisms that explain disparities. Results show that maternal age patterns in LBW risk for African Americans differ from Whites and foreign- and U.S.-born Hispanics. Background socioeconomic disadvantage, together with current socioeconomic status and smoking during pregnancy, explain almost all of the LBW disparity between white teenage mothers and their older counterparts. These findings suggest that social disadvantage is a primary driver in unfavorable birth outcomes among white teenage mothers compared to older white mothers. Alternatively, background disadvantage and other social characteristics explain very little of the LBW disparities among African Americans and U.S.- and foreign-born Hispanics. Overall, these results indicate LBW disparities by maternal age are a complex product of socioeconomic disadvantage and current social and behavioral factors, such that LBW risk does not operate uniformly by race/ethnicity or maternal age.

Explaining Racial Disparities in Infant Health in Brazil

We sought to quantify how socioeconomic, health care, demographic, and geographic effects explain racial disparities in low birth weight (LBW) and preterm birth (PTB) rates in Brazil. We employed a sample of 8949 infants born between 1995 and 2009 in 15 cities and 7 provinces in Brazil. We focused on disparities in LBW (< 2500 g) and PTB (< 37 gestational weeks) prevalence between infants of African ancestry alone or African mixed with other ancestries, and European ancestry alone. We used a decomposition model to quantify the contributions of conceptually relevant factors to these disparities. The model explained 45% to 94% of LBW and 64% to 94% of PTB disparities between the African ancestry groups and European ancestry. Differences in prenatal care use and geographic location were the most important contributors, followed by socioeconomic differences. The model explained the majority of the disparities for mixed African ancestry and part of the disparity for African ancestry alone. Public policies to improve children's health should target prenatal care and geographic location differences to reduce health disparities between infants of African and European ancestries in Brazil.

Explaining racial disparities in infant health in Brazil.

We sought to quantify how socioeconomic, health care, demographic, and geographic effects explain racial disparities in low birth weight (LBW) and preterm birth (PTB) rates in Brazil. We employed a sample of 8949 infants born between 1995 and 2009 in 15 cities and 7 provinces in Brazil. We focused on disparities in LBW (< 2500 g) and PTB (< 37 gestational weeks) prevalence between infants of African ancestry alone or African mixed with other ancestries, and European ancestry alone. We used a decomposition model to quantify the contributions of conceptually relevant factors to these disparities. The model explained 45% to 94% of LBW and 64% to 94% of PTB disparities between the African ancestry groups and European ancestry. Differences in prenatal care use and geographic location were the most important contributors, followed by socioeconomic differences. The model explained the majority of the disparities for mixed African ancestry and part of the disparity for African ancestry alone. Public policies to improve children's health should target prenatal care and geographic location differences to reduce health disparities between infants of African and European ancestries in Brazil.

Spatial Methods to Study Local Racial Residential Segregation and Infant Health in Detroit, Michigan

Over the last several decades, blacks in the United States have experienced substantial health disadvantages compared to other racial and ethnic groups. These disadvantages have been observed for important types of morbidity and early mortality, which public health interventions have achieved limited progress in improving. A promising new direction in health geographic research investigates the relationships among racial residential segregation, neighborhood socioeconomic inequality, and racial health disparities in urban areas of the United States. Historical evidence shows that as class isolation increases in racially segregated neighborhoods, poverty is concentrated, resulting in reduced opportunities and available and accessible amenities and resources, important factors in the promotion and maintenance of population health and well-being. Contemporary evidence shows that the ability to modify the structural constraints that create and exacerbate these unhealthy “place” environments are limited by social and public health policies. This study therefore explores modifiable pathways by which to inform social and public health policy to improve the health of black residents living in concentrated poverty. The historical context of racial residential segregation and neighborhood socioeconomic inequality in the United States is reviewed. A contemporary case study of racial disparities in low birth weight in the Detroit, Michigan, metropolitan area is also presented to demonstrate the persistence of racial health disparities. To address racial health disparities it is recommended that future health policy be linked to housing policy as a way to provide social mobility options for residents living in racially segregated, concentrated poverty neighborhoods.

Racial residential segregation impacts on low birth weight using improved neighborhood boundary definitions

Research on local racial residential segregation and health generally utilize census tract boundaries as a proxy from within which to estimate individual exposures. Census tracts however, may not accurately reflect the neighborhood environments in which people live and interact. Census tract geography may also capture non-exchangeable populations in socially stratified cities, impacting statistical assumptions of independence. To address these concerns, this study assessed the impact of racial residential segregation (i.e., racial isolation and racial clusters) on low birth weight (i.e., intrauterine growth retardation (IUGR) and preterm birth) in the Detroit Metropolitan Area using optimized neighborhood boundary definitions. Automated zone-matching (AZM) methodology was applied to redefine neighborhood (zones). Maternal and infant health information was obtained from Michigan’s vital statistics birth registry (n=137,965) for the years 2004–2006. Multilevel models were estimated to assess the effect of high racial isolation and high racial clusters on IUGR and preterm birth, controlling for maternal race, single marital status, smoking and area-level poverty. The results from this study showed that high racial isolation had a significant effect on IUGR, while the odds of preterm birth were higher in racially clustered zones. African American mothers were at increased odds of having IUGR or preterm infants than other mothers; however, these disparities reduced in highly segregated zones. The predicted incidence of IUGR across racially isolated zones and census tracts differed indicating a modifiable area unit problem (MAUP). MAUP effects were not observed in models predicting preterm incidence in high racial clusters or IUGR or preterm incidence in high poverty areas, demonstrating the stability-reliability of these estimates. Future research should continue to optimize neighborhood boundary definitions, while assessing the sensitivity of segregation measures to changes in scale, to improve our understanding of segregation impacts on racial disparities in low birth weight.

Race disparities in low birth weight in the U.S. south and the rest of the nation

There are well-documented and as yet unexplained disparities in birth outcomes by race in the USA. This paper examines the sources of disparities in low birth weight between blacks and whites in the US, by focusing on differences in disparities between two very distinct geographic areas, the Deep South and the rest of the country. Two findings from prior research drive the analyses: first, health overall is worse in the Deep South states; second, race disparities are smaller in the Deep South than in the rest of the nation. A number of potential explanations for these findings are examined using nationally representative data on approximately 8,000 children born in the US in 2001. Results suggest that, first, almost all of the increased burden of low birth weight in the Deep South states may be explained by differences in race composition and socioeconomic status between the Deep South and rest of the nation. Second, the slightly lower race disparities found in the Deep South states are being driven not by better outcomes for black mothers, but by two other factors: higher returns to socioeconomic status for black mothers and much worse outcomes for poor white mothers in the Deep South compared with the rest of the country.

Low birth weight and parental resources in Italy

This paper studies the disparities in low birth weight in Italy according to socio-economic status, using data updated to 2005. In particular, the two components of low birth weight, prematurity and intrauterine growth retardation, are considered separately. Results of multinomial models show an effect of maternal socio-economic characteristics only for growth retarded births: women who are unmarried and who have low educational level have the highest risks to have restricted foetal growth, even controlling for phy siological aspects. The p rematurity component presents, instead, some inequalities according to father’s employment status. This paternal factor influences also intrauterine growth retardation.

One Size Does Not Fit All: An Examination of Low Birthweight Disparities Among a Diverse Set of Racial/Ethnic Groups

To examine disparities in low birthweight using a diverse set of racial/ethnic categories and a nationally representative sample. This research explored the degree to which sociodemographic characteristics, health care access, maternal health status, and health behaviors influence birthweight disparities among seven racial/ethnic groups. Binary logistic regression models were estimated using a nationally representative sample of singleton, normal for gestational age births from 2001 using the ECLS-B, which has an approximate sample size of 7,800 infants. The multiple variable models examine disparities in low birthweight (LBW) for seven racial/ethnic groups, including non-Hispanic white, non-Hispanic black, U.S.-born Mexican-origin Hispanic, foreign-born Mexican-origin Hispanic, other Hispanic, Native American, and Asian mothers. Race-stratified logistic regression models were also examined. In the full sample models, only non-Hispanic black mothers have a LBW disadvantage compared to non-Hispanic white mothers. Maternal WIC usage was protective against LBW in the full models. No prenatal care and adequate plus prenatal care increase the odds of LBW. In the race-stratified models, prenatal care adequacy and high maternal health risks are the only variables that influence LBW for all racial/ethnic groups. The race-stratified models highlight the different mechanism important across the racial/ethnic groups in determining LBW. Differences in the distribution of maternal sociodemographic, health care access, health status, and behavior characteristics by race/ethnicity demonstrate that a single empirical framework may distort associations with LBW for certain racial and ethnic groups. More attention must be given to the specific mechanisms linking maternal risk factors to poor birth outcomes for specific racial/ethnic groups.

Race, Ethnicity, Concentrated Poverty, and Low Birth Weight Disparities

Race, Ethnicity, Concentrated Poverty, and Low Birth Weight Disparities

A Cross-National Comparison of Racial and Ethnic Disparities in Low Birth Weight in the United States and England

OBJECTIVE. We used 2 new nationally representative surveys to compare racial and ethnic differences in low birth weight in the United States and England.METHODS. Risk factors and rates of low birth weight were compared across groups for singleton births within each country (white, black, Hispanic, Asian, and American Indian mothers in the United States; white, black, and Asian mothers in England). Crude rates and rates adjusted for socioeconomic status and behaviors were compared. Additional comparisons were limited to native-born mothers.RESULTS. Racial and ethnic disparities in low birth weight are as large in England as in the United States. Socioeconomic status and behaviors explain little of the variation across racial and ethnic groups in either country.CONCLUSIONS. Health disadvantages associated with being a minority do not seem to be a uniquely American phenomenon. Universal health care, as provided in the United Kingdom, alone may be insufficient to reduce racial and ethnic disparities in low birth weight.

Racial and Ethnic Disparities in Low Birthweight Among Urban Unmarried Mothers

We examined racial and ethnic disparities in low birthweight (LBW) among unmarried mothers and the extent to which demographic, economic, psychosocial, health, health care, and behavioral factors explain those disparities. Using a sample of 2,412 non-marital births from a national urban birth cohort study, we estimated multiple logistic regression models to examine disparities in LBW between non-Hispanic white (NHW), non-Hispanic black (NHB), U.S.-born Mexican-origin (USMO), and foreign-born Mexican-origin (FBMO) mothers. NHW mothers were almost as likely as NHB mothers to have LBW infants. USMO mothers had 60% lower odds and FBMO mothers had 57% lower odds than NHW mothers of having LBW infants. FBMO mothers had no advantage compared to USMO mothers. Controlling for prenatal health and behaviors substantially reduced the LBW advantages for USMO and FBMO mothers. The odds of LBW for NHB mothers relative to NHW mothers increased with the addition of the same covariates. Racial and ethnic disparities in LBW among unmarried mothers--an economically disadvantaged population--do not mirror those in the general population. Prenatal health and behaviors are strongly associated with LBW in this group and explain a sizable portion of the Mexican-origin advantage. The lack of a significant black-white disparity in this group suggests that poverty plays an important role in shaping racial disparities in the general population. The finding that controlling for prenatal health and behaviors widens rather than narrows the racial disparity suggests that efforts to ameliorate black-white disparities in LBW should focus on social and health risks throughout the life course.

Racial disparities in low birthweight and the contribution of residential segregation: A multilevel analysis

This study investigates the geography of racial disparities in low birthweight in New York City by focusing on racial residential segregation and its effect on the risk of low birthweight among African-American infants and mothers. This cross-sectional multilevel analysis uses birth records at the individual level ( n=96,882) and racial isolation indices at the census tract or neighborhood level ( n=2095) to measure their independent and cross-level effects on low birthweight. This study found that residential segregation and neighborhood poverty operate at different scales to increase the risk of low birthweight. At the neighborhood scale residential segregation is positively and significantly associated with low birthweight, after controlling for individual-level risk factors and neighborhood poverty. Residential segregation explains neighborhood variation in low birthweight means and race effects across census tracts, which cannot be accounted for by neighborhood poverty alone. At the individual scale-increasing levels of residential segregation does not significantly reduce or exacerbate individual-level risk factors for low birthweight; whereas increasing levels of neighborhood poverty significantly eliminates the race effect and reduces the protective effect of being foreign-born on low birthweight, after controlling for other individual-level risk factors and residential segregation. These findings are contradictory to previous health research that shows protective mechanisms associated with ethnic density in local areas. It is likely that structural factors underlying residential segregation, i.e., racial isolation, impose additional stressors on African-American women that may offset or disguise positive attributes associated with ethnic density. However, as poverty is concentrated within these neighborhoods, differences between races in low birthweight cease to exist. This study demonstrates that residential segregation and neighborhood poverty are important determinants of racial disparity in low birthweight in New York City.

Low birth weight and school readiness.

In the United States black women have for decades been twice as likely as white women to give birth to babies of low birth weight who are at elevated risk for developmental disabilities. Does the black-white disparity in low birth weight contribute to the racial disparity in readiness? The author summarizes the cognitive and behavioral problems that beset many low birth weight children and notes that not only are the problems greatest for the smallest babies, but black babies are two to three times as likely as whites to be very small. Nevertheless, the racial disparities in low birth weight cannot explain much of the aggregate gap in readiness because the most serious birth weight-related disabilities affect a very small share of children. The author estimates that low birth weight explains at most 3-4 percent of the racial gap in IQ scores. The author applauds the post-1980 expansions of Medicaid for increasing rates of prenatal care use among poor pregnant women but stresses that standard prenatal medical care cannot improve aggregate birth outcomes substantially. Smoking cessation and nutrition are two prenatal interventions that show promise. Several early intervention programs have been shown to improve cognitive skills of low birth weight children. But even the most promising programs can narrow the readiness gap only a little because their benefits are greatest for heavier low birth weight children and because low birth weight explains only a small share of the gap. The author stresses the importance of reducing rates of low birth weight generally and of extending to all children who need them the interventions that have improved cognitive outcomes among low birth weight children. But because black infants are more likely to be born at the lowest birth weights, preventing low birth weight--when researchers learn how to--is likely to be more effective than early intervention in narrowing birth weight-related racial gaps in school readiness.

Measuring progress in meeting healthy people goals for low birth weight and infant mortality among the 100 largest cities and their suburbs.

We examined the progress of the nation's 100 largest cities and their surrounding suburban areas toward achieving Healthy People 2000/2010 goals for two measures of infant health: low birth weight (LBW) and infant mortality (IM). Using data from the National Center for Health Statistics, we compared 1990 and 2000 urban and suburban LBW and IM rates to target rates for Healthy People 2000 and 2010 objectives. Although the 2000 LBW weight rate for the 100 largest cities was higher than the average for the suburbs (8.9% vs. 7.1%), the increase in LBW rates for the suburbs was nearly four times that of the cities (15.7% vs. 4.1%). Suburban and urban white infants led the increases in LBW rates; urban and suburban black infants showed a slight decrease or no change in LBW rates. Neither cities nor suburbs, on average, met the 2000 target rate of 5%. It appears unlikely that most of the 100 largest cities and suburbs will meet the Healthy People 2010 goal, which remains at 5%, without reductions in preterm births, nationally on the rise. The IM rate declined across most cities and suburbs between 1990 and 2000. However, the 100 largest cities on average did not meet the 2000 IM rate target of 7 infant deaths per 1000 live births; their suburbs did (8.5 vs. 6.4, respectively). The cities and suburbs that did not meet the 2000 target may be especially challenged to meet the 2010 goal for IM unless rates of preterm births are reduced. With the continuing black-white disparities in LBW and IM rates and the overall differences in the racial composition of the largest cities and suburbs, strategies for meeting Healthy People goals will likely need to be targeted to the specific populations they serve.