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Testing the Epidemiologic Paradox of Low Birth Weight in Latinos
Elena Fuentes-Afflick, MD, MPH;
Nancy A. Hessol, MSPH;
Eliseo J. Pérez-Stable, MD
Arch Pediatr Adolesc Med. 1999;153:147-153.
Background Rates of low-birth-weight (LBW) infants are similar between Latina and white women, an epidemiologic paradox. However, few studies have analyzed the relationship between ethnicity, Latino subgroup, confounding variables, and LBW.
Methods We analyzed 395,070 singleton livebirths to Latina and non-Latina white women in California during 1992. Multivariate logistic regression was used to estimate odds ratios (ORs) and 95% confidence intervals (CIs) for the risks due to Latino ethnicity and Latino subgroup for very LBW (VLBW, 500-1499 g) and moderately LBW (MLBW, 1500-2499 g) outcomes.
Results Latina and white women had similar unadjusted rates of VLBW (0.7% vs 0.6%) and MLBW infants (3.7% vs 3.4%). After adjusting for maternal age, education, birthplace, marital status, parity, tobacco use, use of prenatal care, infant sex, and gestational age, there was no difference in the odds of VLBW infants between Latina and white women (OR, 0.93 [95% CI, 0.81-1.07]). Latina women had minimally elevated odds of MLBW infants (OR, 1.06 [95% CI, 1.01-1.11]) compared with white women. By Latino subgroup, there was no difference in the adjusted odds of VLBW infants among Central and South American, Cuban, Mexican, Puerto Rican, and white women. The adjusted odds of MLBW infants were elevated among Central and South American (OR, 1.14 [95% CI, 1.05-1.25]) and Puerto Rican women (OR, 1.41 [95% CI, 1.12-1.78]), relative to white women.
Conclusions The epidemiologic paradox of LBW in Latinos is valid. New conceptual models are needed to identify Latina women who are at risk for adverse pregnancy outcomes.
From the Departments of Pediatrics (Dr Fuentes-Afflick), Epidemiology and Biostatistics (Dr Fuentes-Afflick), Medicine (Ms Hessol and Dr Pérez-Stable), and Obstetrics, Gynecology, and Reproductive Sciences (Ms Hessol), the Medical Effectiveness Research Center for Diverse Populations (Drs Fuentes-Afflick and Pérez-Stable), the Institute for Health Policy Studies (Dr Fuentes-Afflick), and the Division of General Internal Medicine (Dr Pérez-Stable), School of Medicine, University of California, San Francisco.
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