Identifying multiple risks of low birth weight using person-centered modeling.

OBJECTIVES: Low birth weight outcomes result from multiple potential risks. The present study used latent class analysis to identify subgroups of women with multiple co-occurring risks and to examine the relationship of these risk classes to low birth weight outcome. METHODS: Data were analyzed on all live singleton births in 2010 and 2011 in West Virginia (N = 28,820). Ten risks were examined including marital status, stress, mother's age, parity status, reported smoking and drug use during pregnancy, delayed prenatal care, Medicaid coverage, uninsurance, and low education. RESULTS: Six latent classes were identified that ranged from a low-risk referent group to higher risk classes characterized by unique constellations of risk factors. Compared with the low-risk referent, all of the remaining five latent classes were significantly associated with increased odds of low birth weight. However, one class was at especially high risk; this class was characterized by unmarried women in the Medicaid program who reported drug use, smoking, stress, and late prenatal care (odds ratio, 4.78; 95% confidence interval, 4.07-5.61). CONCLUSIONS: The person-centered approach identified subgroups of women with unique risk profiles. The results suggest that eliminating a single risk would not resolve the low birth weight problem. Smoking, for example, co-occurs with higher stress and higher levels of drug use among a Medicaid population. It may be beneficial to develop and test tailored interventions to groups with specific co-occurring risks to reduce low birth weight outcomes. Programs targeted to women in the Medicaid program who also engage in substance use and experience stress are especially indicated.

WV Birth Score: maternal smoking and drugs of abuse.

The WV Birth Score began in 1984 and was revised in 2007. One part of the form is a score which predicts the top 18% of infants at risk for death in the first year of life. The other components collect information regarding the health of mothers and their infants. Data from the WV Birth Score between 2001 and 2009 reveal that the average smoking rate among mothers was 28.5%. The average maternal tobacco use rate among High Score infants (53.7%) is significantly higher than the average rate among mothers of Low Score infants (23.6%) (p < .0001). Infants born to women who smoked during pregnancy in 2007 weighed 250 grams less than infants of non-smoking women (p < 0.0001). A question on drug exposures during pregnancy reveals that marijuana is the most commonly reported drug on the Birth Score form. Only 5% of the mothers reported using at least one substance during their pregnancy. Smoking rates during pregnancy in WV are among the highest in the nation and lead to higher mortality rates in the infant born to mothers who smoke. Programs to impact smoking and other maternal health issues should be a priority in WV.