Low Birth Weight in America is racial? Not so fast.

Low Birth Weight in America.

            Health issues always get my attention. Naturally, when I saw a segment of the program “Unnatural Causes” on PBS indicating a connection between health and race my ears perked up. I’m not a doctor, but I am a relentless researcher who likes to dig into fashionable hypotheses.

            I was a little disappointed with the PBS findings, specifically on infant mortality. The focus of the PBS program was on the highest number of children born of low birth weight to Black Americans. They noted that when an African person moved to the U.S. from another country, within a generation the children born has a higher chance of being prematurely born and of low birth weight. The study made allowances for low birth weight due to lower education, social status, bad nutrition, alcohol, cigarettes, etc. A child with low birth weight has high odds that he/she will not make it to his/her first birthday. Thus, in the end, it becomes an issue of mortality.

            The assumption was that racial inequity was the culprit. It was indicated that stress was the major factor and that due to racism, this stress (an over abundance of the hormone cortisol that impairs the immune function) affected the birth of the children. The assumption does have merit. However, the PBS program failed to consider other races.

            The graph below indicates my concern. Notice, regardless of race, there is a large percentage of low birth weight in American children.

QuickStats from the National Center for Health Statistics
Morbidity and Mortality Report (MMWR) v.54, n.5, 11feb2005

            The question shouldn’t be why do Black American babies have such a low birth weight, but rather why do all American babies have such a low birth weight? Yes, Blacks have the highest incident of low birth weight. But Hawaiians and American Indians are close behind. It’s easy to point to the racial element, and indeed it may be a factor, but there is more to consider.

            Even without black women as a statistic, U.S. infant mortality is higher than many other countries. See Figure below. You will notice that the U.S. rate climbed from 6.8 to 7.0 in one year.

 

            In the PBS episode, Neonatologist Richard David stated that “White Americans, if they were a separate country, would still rank 23^rd in the world.”        (The U.S. was 12th in the world in 1960).

            After quoting this fact, the PBS narrator continued to say that “racism is taking a heavy toll on African-American children even before they leave their mother’s womb. It’s an idea that’s slowly gaining acceptance.” This statement baffles me. After stating that white infant mortality is higher than most developing nations, it is obvious that all American women should be concerned—not only blacks.  

            PBS narrator: “African immigrants to the U.S….take only one generation before their daughters are at risk of having premature babies.” Since America is at a high rate overall, I suspect that the same condition occurs for all people immigrating.

            There is something that is happening within the lives of the people living in the U.S. that causes it.  

Fact 1

            Preteen birth, and peak child birth age (20-early 30s) rates are down, and women in their late 30s and early 40s are up.  There is a possibility that older women may be skewing the results.

Fact 2

            Access to prenatal care is increasing, not decreasing. Therefore, prenatal care is not a factor.

Fact 3

            Stillbirth and miscarriages are not counted at infant mortality deaths in many other countries. Another fact that brings the U.S. closer to other developed nations.

            So far three important facts were either noted or overlooked in the PBS program. In any case, I wanted to find a more substantial correlation between women and the low birth weight or infant mortality. Since most women have low birth rates after moving to America, I thought that location may have an affect.

           

            The chart below indicates infant mortality by state. The western states and a few others have a rate of about 6%, the southwest 9% or more.

Source: National Center for Health Statistics. Health, United States, 2004 

            Something about the infant mortality chart reminded me of another chart…Obesity. The next chart shows obesity by state.

            Both the infant mortality and obesity charts have lower rates in the west and higher rates in the southeast. I couldn't believe the obvious connection and wondered if it was true.

            It was stated earlier in the PBS episode that stress was a major factor in low birth weight. Stress on a woman affects the body in many ways. A women’s body responds to stress by the secretion of the hormone cortisol. Prolonged levels of cortisol in the bloodstream have been responsible for storing increased abdominal fat, blood sugar imbalances, higher blood pressure, lower immunity and inflammatory responses, etc. Excess weight and hypertension, or high blood pressure, are tied closely together. Losing even 10 pounds can lower blood pressure.

            In other words, stress leads to a potential for obesity and obesity leads to hypertension.

The American Heart Association says “The association between low birth weight and high blood pressure is well established…High blood pressure can be dangerous for both mother and baby.”

            Since black American women have higher rates of low birthed babies, it would be expected that they would have obesity and hypertension. The next graph is from the Health Resources and Services Administration U.S. Department of Health and Human Services

    

        These two charts show that black American women have the highest percentage of weight and hypertension over whites, Hispanics, and other races. However, a majority of all women over the age of 18 are overweight.

            An article containing research on just this situation was published in July of 2010 by a UK medical research group known as BMJ. The verbose title: “Overweight and obesity in mothers and risk of preterm birth and low birth weight infants: systematic review and meta-analyses.” The objective of the study was to “determine the relation between overweight and obesity in mothers and preterm birth…”

          The BMJ group’s conclusions are as follows. “In conclusion, overweight and obese women have higher risks of preterm birth before 32 weeks and induced preterm birth before 37 weeks, and accounting for publication bias, possible preterm birth before 37 weeks overall. Unlike many causes of preterm birth, maternal overweight and obesity represent a potentially preventable cause of the leading source of neonatal mortality and morbidity and morbidity through childhood.”

            The BMJ’s recommendation. “Ideally, overweight or obese women should have prepregnancy counseling so that they are informed of their prenatal risks and can try to optimize their weight before pregnancy.”

            This data analysis combined information from 84 studies with women throughout the world. It proves that all women everywhere are affected. The abstract was technical and the footnotes lengthy. This link will provide the article and sources. http://www.bmj.com//node/382566?variant=full-text

            I contend that the fundamental issue noted by PBS is not a race problem, but rather an American problem. Even though it is overwhelming that black women carry the burden of being labeled with such sad statistics for birthing, it is vitally important that all American woman pay attention to low birth weight and preterm causes.

            Setting aside the obvious factors such as smoking, alcohol, and socioeconomic factors, high blood pressure caused by obesity is a major stress factor.  It is proven that obese women have higher risks, and black women lead the country in obesity. I don’t want to diminish the fact that stress may be an important component. However, if black women are assumed to be suffering from stress, then the evidence would also conclude that Hawaiians, American Indians, and other races suffer from it too. 

            As for today, the key to the health of any pregnant woman is to think more about their diet, exercise, and relaxation to keep weight and blood pressure under control. If there are stressors in a woman’s life, pregnancy counseling, as noted by the BMJ group, is vital to a healthy full term birth. The health of our 
American babies depend on it.

Additional Charts