title: Identifying multiple risks of low birth weight using person-centered modeling.
abstract: OBJECTIVE
  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.
authors.affiliation: Department of Applied Health Science, School of Public Health, Indiana University, Bloomington, Indiana. Electronic address: hendryx@indiana.edu.
authors.forename: Michael
authors.initials: M
authors.lastname: Hendryx
authors.affiliation: Department of Epidemiology and Biostatistics, School of Public Health, Indiana University, Bloomington, Indiana.
authors.forename: Juhua
authors.initials: J
authors.lastname: Luo
authors.affiliation: Department of Environmental and Occupational Health Sciences, School of Public Health, West Virginia University, Morgantown, West Virginia.
authors.forename: Sarah S
authors.initials: SS
authors.lastname: Knox
authors.affiliation: Department of Social and Behavioral Sciences, School of Public Health, West Virginia University, Morgantown, West Virginia.
authors.forename: Keith J
authors.initials: KJ
authors.lastname: Zullig
authors.affiliation: Department of Pediatrics, School of Medicine, West Virginia University, Morgantown, West Virginia.
authors.forename: Lesley
authors.initials: L
authors.lastname: Cottrell
authors.affiliation: Department of Pediatrics, School of Medicine, West Virginia University, Morgantown, West Virginia.
authors.forename: Candice W
authors.initials: CW
authors.lastname: Hamilton
authors.affiliation: Department of Pediatrics, School of Medicine, West Virginia University, Morgantown, West Virginia.
authors.forename: Collin C
authors.initials: CC
authors.lastname: John
authors.affiliation: Department of Pediatrics, School of Medicine, West Virginia University, Morgantown, West Virginia.
authors.forename: Martha D
authors.initials: MD
authors.lastname: Mullett
mesh_terms: D003430:Cross-Sectional Studies; D005260:Female; D015438:Health Behavior; D006801:Humans; D007230:Infant, Low Birth Weight; D007231:Infant, Newborn; D017533:Marital Status; D008423:Maternal Age; D008484:Medicaid; D011247:Pregnancy; D011256:Pregnancy Outcome / Q000453:epidemiology*; D011295:Prenatal Care; D012307:Risk Factors; D012907:Smoking / Q000009:adverse effects / Q000453:epidemiology; D012959:Socioeconomic Factors; D014481:United States; D014903:West Virginia