Maternal Birthplace is Associated with Low Birth Weight Within Racial/Ethnic Groups

Abstract

Introduction While disparities in low birth weight (LBW) incidence by racial/ethnic group are well known, differences in LBW incidence by maternal birthplace within racial/ethnic groups, and particularly, differences after adjustment for pregnancy complications, are less clear. Methods We conducted a population-based study of LBW using 113,760 singleton, live birth records from King County, Washington (2008–2012), a region in the Pacific Northwest with a large immigrant population. Study participants were Asian, non-Hispanic black, Hispanic, Native Hawaiian/Other Pacific Islander (NHOPI), and non-Hispanic white women. Using multivariable logistic regression models, we calculated odds ratios (ORs) and 95% confidence intervals (CIs) to estimate relative risk of LBW (<2,500 g) related to maternal race/ethnicity and birthplace (defined by the Millennium Development Goals Regional Groupings). Results Compared with non-Hispanic white women, non-Hispanic black, Asian Indian, Filipino, Japanese, and Vietnamese women had 1.57–2.23-fold higher, statistically significant, risk of having a LBW infant, and NHOPI and Mexican women had 1.30–1.33-fold, statistically significant, higher risk. LBW risk was lower for Asian women from Eastern Asia (OR 0.68, 95% CI 0.55–0.85), non-Hispanic black women from Sub-Saharan Africa (OR 0.58, 95% CI 0.47–0.73), and non-Hispanic white women from other developed countries (OR 0.83, 95% CI 0.69–1.00), as compared with their US-born racial/ethnic counterparts. Results were, in general, similar after adjustment for pregnancy complications. Conclusions Compared with most other racial/ethnic groups, non-Hispanic whites had lower risk of LBW. Foreign-born women had lower risk of LBW compared with their US-born counterparts in the majority of racial/ethnic groups. Pregnancy complications had minimal effect on the associations.

Pregnancy health and perinatal outcomes among Pacific Islander women in the United States and US Affiliated Pacific Islands: Protocol for a scoping review

“…Several studies acknowledged that disaggregating Pacific Islander ethnicities into their individual subgroups would have strengthened their analyses, but in many cases, they cited small sample size as a barrier to doing so [ 35 , 43 , 50 , 58 , 67 , 69 ]. Despite the fact that 0.4% of the U.S. population identified as Pacific Islander in the 2020 census [ 82 ], and that this group grew by 35% from 2000 to 2010 [ 16 ] (more than three times faster than the rate of the overall U.S. population) and another 28% between 2010 and 2020 [ 82 ], representation – particularly in studies using national-level data – fell short of what may have been expected.…”

“…Notably, several studies of pregnancy hypertension and diabetes had to be excluded for not distinguishing between pre-existing and pregnancy-induced dysfunction. [ 20 , 88 ] While the main goal of this paper was not to compare Pacific Islanders’ risk for poor pregnancy/perinatal outcomes to those of other groups, but rather to identify gaps in the research, it should be noted that the majority of studies found that Pacific Islanders had higher prevalence, risk, or odds of having adverse outcomes compared to their white counterparts [ 27 – 32 , 34 – 39 , 41 – 49 , 51 , 52 , 58 – 65 , 67 – 73 ]. The underlying cause of these disparities needs further research but may be due to lack of healthcare access, discrimination, or other social determinants as have been reported among other U.S. minority/immigrant populations [ 89 , 90 ].…”

Comparison of adverse perinatal outcomes between Asians and Caucasians: a population-based retrospective cohort study in Ontario

“…First, this study is based on a large population with comprehensive demographic and health care information, allowing an investigation of a number of adverse perinatal outcomes with appropriate adjustment for potential confounding factors. Second, our study has a large sample size of Asian women, enabling a robust comparison between Caucasians and Asians with greater than at least 90% power to detect the difference for each perinatal outcome with a two-tailed alpha (type 1 error) of 5%, where previous studies had smaller samples of Asians [ 1 , 7 , 18 , 54 , 55 ]. Third, universal access to quality maternity care helped to isolate maternal factors from health care factors.…”

Multicomponent Informed Consent with Marshallese Participants

“…Marshallese in the United States experience significant health disparities and report a high prevalence of diabetes, heart disease, and obesity (Hawley & McGarvey, 2015;Look et al, 2013;Mau et al, 2009;McElfish et al, 2017aMcElfish et al, , 2017bOkihiro & Harrigan, 2005;Schiller et al, 2012;Tung, 2012;US Department of Health & Human Services Office of Minority Health, 2015). Furthermore, Marshallese mothers are disproportionately likely to have poor maternal health outcomes compared to other racial and/or ethnic groups (Centers for Disease Control & Prevention, 2011;Chang et al, 2010Chang et al, , 2015Lavery et al, 2017;Nembhard et al, 2019aNembhard et al, , 2019bRao et al, 2006;Silva et al, 2006;Tsitas et al, 2015;Wartko et al, 2017). Pacific Islanders, and Marshallese specifically, are also underrepresented in research, which perpetuates and further obscures these health disparities impacting this vulnerable community (Compact of Free Association Community Advocacy Network, 2014;McGrath & Ka'ili, 2010;Palafox et al, 2002;Roehr, 2010).…”