title: Very low birth weight and perinatal periods of risk: disparities in St. Louis.
abstract: OBJECTIVE
  Very low birth weight (VLBW) is a significant issue in St. Louis, Missouri. Our study evaluated risk factors associated with VLBW in this predominantly urban community.
  
  
  METHODS
  From 2000 to 2009, birth and fetal death certificates were evaluated (n = 160, 189), and mortality rates were calculated for perinatal periods of risk. The Kitagawa method was used to explore fetoinfant mortality rates (FIMR) in terms of birth weight distribution and birthweight specific mortality. Multivariable logistic regression was used to assess the magnitude of association of selected risk factors with VLBW.
  
  
  RESULTS
  VLBW contributes to 50% of the excess FIMR in St. Louis City and County. The highest proportion of VLBW can be attributed to black maternal race (40.6%) in St. Louis City, inadequate prenatal care (19.8%), and gestational hypertension (12.0%) among black women. Medicaid was found to have a protective effect for VLBW among black women (population attributable risk (PAR) = -14.5).
  
  
  CONCLUSIONS
  Interventions targeting the health of women before and during conception may be most successful at reducing the disparities in VLBW in this population. Interventions geared towards smoking cessation and improvements in Medicaid and prenatal care access for black mothers and St. Louis City residents can greatly reduce VLBW rates.
authors.affiliation: Saint Louis University, College for Public Health & Social Justice, 3545 Lafayette Avenue, Saint Louis, MO 63104, USA.
authors.forename: Pamela
authors.initials: P
authors.lastname: Xaverius
authors.affiliation: Saint Louis University, College for Public Health & Social Justice, 3545 Lafayette Avenue, Saint Louis, MO 63104, USA.
authors.forename: Joanne
authors.initials: J
authors.lastname: Salas
authors.affiliation: Lindenwood University, 209 S Kingshighway Street, St. Charles, MO 63301, USA.
authors.forename: Deborah
authors.initials: D
authors.lastname: Kiel
authors.affiliation: Saint Louis University, College for Public Health & Social Justice, 3545 Lafayette Avenue, Saint Louis, MO 63104, USA.
authors.forename: Candice
authors.initials: C
authors.lastname: Woolfolk
mesh_terms: D000328:Adult; D002648:Child; D005006:Ethnicity; D005260:Female; D005313:Fetal Death; D006801:Humans; D046110:Hypertension, Pregnancy-Induced / Q000453:epidemiology*; D007231:Infant, Newborn; D019102:Infant, Very Low Birth Weight; D008923:Missouri / Q000453:epidemiology; D018743:Perinatal Care; D011247:Pregnancy; D012307:Risk Factors; D012959:Socioeconomic Factors