Addressing Racial and Ethnic Disparities to Improve Low Birthweight for Minority Women

by Brittany Carlson, MPH Candidate ‘18

Birthweight is an important predictor of infant health, development, and mortality. Those born with low or very low birthweight are more susceptible to health complications during infancy and are more likely to develop chronic conditions later on in life.1 Data has shown that babies born with low birthweight (less than 5 pounds 8 ounces) are at higher risk of infant mortality, with risk in very low birthweight (3 pounds 5 ounces) babies being more than 100 times greater than those born at a normal birthweight.2 Prior analyses have also noted significant racial disparities in birthweight, infant health, and outcomes.3

The World Health Organization (WHO) has identified low birthweight as a public health concern, suggesting 15.5% of all births to be of low birthweight.4 Although more prevalent in developing countries, the rate of low birthweight across the United States varies from approximately 5.9% to 11.3%.5 In Massachusetts, 7.7% of births in 2015 and 7.5% of births in 2016 were to low birthweight babies.5,6 While the overall rate of low birthweight was 8.6% in the Greater Boston area in 2015, the rate was 15% for women seeking care at DotHouse Health, a federally qualified health center in Dorchester. Despite several changes implemented by the health center to improve prenatal care and maternal screening, DotHouse Health has continued to see a higher incidence of low birthweight babies born to non-white women.

I conducted my Applied Learning Experience (ALE) at DotHouse under the direction of Quyen Pham, Quality and Reporting Coordinator. The project was aimed at identifying the risk factors that contribute to higher incidences of low birthweight babies, as well as identifying associations between race and/or ethnicity and birthweight. The project was completed through a comprehensive literature review of risk factors and low birthweight, patient chart reviews, observation studies, and key informant interviews. Presence of maternal risk factors, age at pregnancy, gestational age, and weight at birth were collected from chart reviews and diagnosis codes applied to prenatal visits. Differences in proportions and means were calculated to compare risk factors among different race and ethnic groups. A logistic regression was also conducted to identify associations between several risk factors and the odds of having a low birthweight baby.

Similar to prior studies, the findings of the analysis identified smoking and gestational age to be the most significant risk factors associated with low birthweight among those receiving care at DotHouse. Although additional risk factors were found to increase risk, no other significant associations were identified. The findings of the analysis and discussions with key informants were utilized to make suggestions to the health center on how to improve prenatal care and birthweight.

Although more research is needed to better gauge the association of low birthweight and stressors in patients receiving care at DotHouse Health, the initial findings of the study highlighted several areas for improvement. Recommendations were made to the staff to better screen for stressors and the effect of socioeconomic status on pregnancy, emphasize smoking cessation early on in family planning and prenatal care, and utilize case management. With these recommendations and a better understanding of stressors on the population, DotHouse Health can implement changes that can reduce the incidence of low birthweight babies.

While working on my ALE at DotHouse I had the opportunity to meet and discuss prenatal care and birthweight with several members of the Women’s Health team, as well as create a dataset to analyze. Through this process I learned a lot about collaborating with staff, being flexible and open to changes, and applying the skills I developed while studying at Tufts to a real-world problem. Although the findings of my project were not enough to eliminate the issue, it is rewarding to know that the work I completed provided the staff with a better understanding of the risk factors driving low birthweight incidence and generated new ideas for further research. Linda Hudson, ScD, MSPH, Assistant Professor of Public Health and Community Medicine was instrumental in assisting me in developing and completing this project and Kenneth Chui, PhD, MPH, MS, Assistant Professor of Public Health and Community Medicine in helping me with the analysis.

1. http://www.childrenshospital.org/conditions-and-treatments/conditions/low-birthweight-in-newborns/symptoms-and-causes
2. Martin JA, Hamilton BE, Osterman MJK, et al. Births: Final data for 2013. National vital statistics reports; vol 64 no 1. Hyattsville, MD: National Center for Health Statistics. 2015.
3. Hamilton BE, Martin JA, Osterman MJK, et al. Births: Final data for 2014. National vital statistics reports; vol 64 no 12. Hyattsville, MD: National Center for Health Statistics. 2015.
4. United Nations Children’s Fund and World Health Organization, Low Birthweight: Country, regional and global estimates. UNICEF, New York, 2004.
5. Martin JA, Hamilton BE, Osterman MJK, et al. Births: Final data for 2015. National vital statistics report; vol 66, no 1. Hyattsville, MD: National Center for Health Statistics. 2017.
6. http://www.americashealthrankings.org/explore/2015-annualreport/measure/birthweight/state/MA

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