title: Risk Factors Associated with Very Low Birth Weight in a Large Urban Area, Stratified by Adequacy of Prenatal Care.
abstract: OBJECTIVE
  This study examined risk and protective factors associated with very low birth weight (VLBW) for babies born to women receiving adequate or inadequate prenatal care.
  
  
  METHODS
  Birth records from St. Louis City and County from 2000 to 2009 were used (n = 152,590). Data was categorized across risk factors and stratified by adequacy of prenatal care (PNC). Multivariate logistic regression and population attributable risk (PAR) was used to explore risk factors for VLBW infants.
  
  
  RESULTS
  Women receiving inadequate prenatal care had a higher prevalence of delivering a VLBW infant than those receiving adequate PNC (4.11 vs. 1.44 %, p < .0001). The distribution of risk factors differed between adequate and inadequate PNC regarding Black race (36.4 vs. 79.0 %, p < .0001), age under 20 (13.0 vs. 33.6 %, p < .0001), <13 years of education (35.9 vs. 77.9 %, p < .0001), Medicaid status (35.7 vs. 74.9, p < .0001), primiparity (41.6 vs. 31.4 %, p < .0001), smoking (9.7 vs. 24.5 %, p < .0001), and diabetes (4.0 vs. 2.4 %, p < .0001), respectively. Black race, advanced maternal age, primiparity and gestational hypertension were significant predictors of VLBW, regardless of adequate or inadequate PNC. Among women with inadequate PNC, Medicaid was protective against (aOR 0.671, 95 % CI 0.563-0.803; PAR -32.6 %) and smoking a risk factor for (aOR 1.23, 95 % CI 1.01, 1.49; PAR 40.1 %) VLBW. When prematurity was added to the adjusted models, the largest PAR shifts to education (44.3 %) among women with inadequate PNC.
  
  
  CONCLUSIONS
  Community actions around broader issues of racism and social determinants of health are needed to prevent VLBW in a large urban area.
authors.affiliation: Department of Epidemiology, College for Public Health and Social Justice, Saint Louis University, 3545 Lafayette Ave., Saint Louis, MO, 63104, USA. pxaveriu@slu.edu.
authors.forename: Pamela
authors.initials: P
authors.lastname: Xaverius
authors.affiliation: Department of Epidemiology, College for Public Health and Social Justice, Saint Louis University, 3545 Lafayette Ave., Saint Louis, MO, 63104, USA.
authors.forename: Cameron
authors.initials: C
authors.lastname: Alman
authors.affiliation: Department of Pediatrics, School of Medicine, Washington University, 660 S. Euclid Ave., Saint Louis, MO, 63110, USA.
authors.forename: Lori
authors.initials: L
authors.lastname: Holtz
authors.affiliation: Department of Epidemiology, College for Public Health and Social Justice, Saint Louis University, 3545 Lafayette Ave., Saint Louis, MO, 63104, USA.
authors.forename: Laura
authors.initials: L
authors.lastname: Yarber
mesh_terms: D000328:Adult; D015331:Cohort Studies; D004522:Educational Status; D005260:Female; D006801:Humans; D046110:Hypertension, Pregnancy-Induced / Q000453:epidemiology; D007231:Infant, Newborn; D007234:Infant, Premature; D019102:Infant, Very Low Birth Weight; D016015:Logistic Models; D008423:Maternal Age; D008484:Medicaid; D008923:Missouri / Q000453:epidemiology; D015999:Multivariate Analysis; D010298:Parity; D010342:Patient Acceptance of Health Care / Q000523:psychology* / Q000706:statistics & numerical data; D011247:Pregnancy; D011295:Prenatal Care / Q000706:statistics & numerical data*; D015995:Prevalence; D065840:Protective Factors; D012307:Risk Factors; D014481:United States; D014505:Urban Population / Q000706:statistics & numerical data; D055815:Young Adult
keywords: Prenatal care; Risk factors; Social determinants of health; Very low birth weight