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Maternal and Child Health Journal

, Volume 12, Issue 5, pp 549–556 | Cite as

Heterogeneity within Asian Subgroups: A Comparison of Birthweight Between Infants of US and Non-US Born Asian Indian and Chinese Mothers

  • Donald K. Hayes
  • Susan L. Lukacs
  • Kenneth C. Schoendorf
Article

Abstract

Objectives Birthweight distributions and proportions of low birthweight (LBW) are commonly used to assess the health of populations. However, the “population” is difficult to define due to differences by race, socioeconomic status, age distribution, and cultural identity. This study analyzes birth outcomes in two Asian subgroups to examine variation within the Asian population. Methods Analysis of the 1998–2003 National Center for Health Statistics’ natality file for 293,211 singleton births in Asian Indian and Chinese mothers compared birthweight distributions, mean birthweights, proportions of very low birthweight (VLBW) and moderately low birthweight (MLBW) infants, and the influence of maternal nativity on these outcomes. A multiple logistic regression analysis, stratified by maternal nativity, was done to control for established confounders of maternal age, marital status, education, and parity. Results Maternal characteristics and birthweight distributions varied by race subgroup and nativity. Infants of Asian Indian mothers had a lower mean birthweight and higher proportions of VLBW and MLBW than Chinese. After controlling for differences in maternal characteristics, infants of US born Asian Indian mothers were more likely to be VLBW (AOR 1.87, 95% CI: 1.27–2.75) or MLBW (AOR 1.59, 1.39–1.82) than infants of US born Chinese mothers. Similarly, infants of non-US born Asian Indian mothers were more likely to be VLBW (AOR 2.13, 2.06–2.21) or MLBW (AOR 2.26, 2.18–2.35) then infants of non-US born Chinese mothers. Conclusions Our study demonstrates variation in birth outcomes by maternal race and nativity in two Asian subgroups. The heterogeneity within a single commonly used “population” is likely not limited to these two Asian subgroups, but is probably applicable to many populations in the United States. Analyses should try to account for these differences to ensure a more accurate representation of various populations in the US. The difficulty of defining a population by race adds to the complexity of examining disparities in birth outcomes.

Keywords

Low birthweight Asian Indian Chinese Populations Birth outcomes 

References

  1. 1.
    Alshimmiri, M. M., Hammoud, M. S., Al-Saleh, E. A., & Alsaeid, K. M. (2003). Ethnic variations in birthweight percentiles in Kuwait. Paediatric and Perinatal Epidemiology, 17(4), 355–362.PubMedCrossRefGoogle Scholar
  2. 2.
    Mathai, M., Jacob, S., & Karthikeyan, N. G. (1996). Birthweight standards for south Indian babies. Indian Pediatrics, 33(3), 203–209.PubMedGoogle Scholar
  3. 3.
    Wen, S. W., Kramer, M. S., & Usher, R. H. (1995). Comparison of birth weight distributions between Chinese and Caucasian infants. American Journal of Epidemiology, 141(12), 1177–1187.PubMedGoogle Scholar
  4. 4.
    Wilcox, A., & Russell, I. (1990). Why small black infants have a lower mortality rate than small white infants: The case for population-specific standards for birth weight. The Journal of Pediatrics, 116(1), 7–10.PubMedCrossRefGoogle Scholar
  5. 5.
    Martin, J. A., Hamilton, B. E., Sutton, P. D., Ventura, S. J., Menacker, F., & Munson, M. L. (2005). Births: Final data for 2003. National Vital Statistics Reports, 52(2), 1–116.Google Scholar
  6. 6.
    Office of Management and Budget. (1977). Race and ethnic standards for Federal statistics and administrative reporting. Statistical Policy Directive 15.Google Scholar
  7. 7.
    Frisbie, W. P., Cho, Y., & Hummer, R. A. (2001). Immigration and the health of Asian and Pacific Islander adults in the United States. American Journal of Epidemiology, 153(4), 372–380.PubMedCrossRefGoogle Scholar
  8. 8.
    Lin-Fu, J. S. (1988). Population characteristics and health care needs of Asian Pacific Americans. Public Health Reports, 103(1), 18–27.PubMedGoogle Scholar
  9. 9.
    Le, L. T., Kiely, J. L., & Schoendorf, K. C. (1996). Birthweight outcomes among Asian American and Pacific Islander subgroups in the United States. International Journal of Epidemiology, 25(5), 973–979.PubMedCrossRefGoogle Scholar
  10. 10.
    Baker, L. C., Afendulis, C. C., Chandra, A., McConville, S., Phibbs, C. S., & Fuentes-Afflick, E. (2007). Differences in neonatal mortality among whites and Asian American subgroups: Evidence from California. Archives of Pediatrics & Adolescent Medicine, 161(1), 69–76.CrossRefGoogle Scholar
  11. 11.
    Fuentes-Afflick, E., & Hessol, N. A. (1997). Impact of Asian ethnicity and national origin on infant birth weight. American Journal of Epidemiology, 145(2), 148–155.PubMedGoogle Scholar
  12. 12.
    Qin, C., & Gould, J. B. (2006). The Asian birth outcome gap. Paediatric and Perinatal Epidemiology, 20(4), 279–289.PubMedCrossRefGoogle Scholar
  13. 13.
    Singh, G. K., & Yu, S. M. (1996). Adverse pregnancy outcomes: Differences between US- and foreign-born women in major US racial and ethnic groups. American Journal of Public Health, 86(6), 837–843.PubMedGoogle Scholar
  14. 14.
    Fang, J., Madhavan, S., & Alderman, M. H. (1999). Low birth weight: Race and maternal nativity – Impact of community income. Pediatrics, 103(1), E5.PubMedCrossRefGoogle Scholar
  15. 15.
    Fuentes-Afflick, E., Hessol, N. A., & Perez-Stable, E. J. (1998). Maternal birthplace, ethnicity, and low birth weight in California. Archives of Pediatrics & Adolescent Medicine, 152(11), 1105–1112.Google Scholar
  16. 16.
    Gould, J. B., Madan, A., Qin, C., & Chavez, G. (2003). Perinatal outcomes in two dissimilar immigrant populations in the United States: a dual epidemiologic paradox. Pediatrics, 111(6 Pt 1), e676–682.PubMedCrossRefGoogle Scholar
  17. 17.
    Martin, J. A. (1995). Birth characteristics for Asian or Pacific Islander subgroups, 1992. Monthly Vital Statistics Report, 43(10 Suppl), 1–12.Google Scholar
  18. 18.
    National Center for Health Statistics. (2002). Public use data file documentation: 2000 Detail natality. Hyattsville, MD: GPO.Google Scholar
  19. 19.
    David, R. J., Collins, J. W. Jr. (1997). Differing birth weight among infants of U.S.-born blacks, African-born blacks, and U.S.-born whites. The New England Journal of Medicine, 337(17), 1209–1214.PubMedCrossRefGoogle Scholar
  20. 20.
    Madan, A., Holland, S., Humbert, J. E., & Benitz, W. E. (2002). Racial differences in birth weight of term infants in a northern California population [comment]. Journal of Perinatology, 22(3), 230–235.PubMedCrossRefGoogle Scholar
  21. 21.
    Singh, G. K., & Yu, S. M. (1994). Birthweight differentials among Asian Americans. American Journal of Public Health, 84(9), 1444–1449.PubMedGoogle Scholar
  22. 22.
    Acevedo-Garcia, D., Soobader, M. J., & Berkman, L. F. (2005). The differential effect of foreign-born status on low birth weight by race/ethnicity and education. Pediatrics, 115(1), e20–e30.PubMedGoogle Scholar
  23. 23.
    Alexander, G. R., Mor, J. M., Kogan, M. D., Leland, N. L., & Kieffer E. (1996). Pregnancy outcomes of US-born and foreign-born Japanese Americans. American Journal of Public Health, 86(6), 820–824.PubMedGoogle Scholar
  24. 24.
    Guendelman, S., Buekens, P., Blondel, B., Kaminski, M., Notzon, F. C., & Masuy-Stroobant, G. (1999). Birth outcomes of immigrant women in the United States, France, and Belgium. Maternal and Child Health Journal, 3(4), 177–187.PubMedCrossRefGoogle Scholar
  25. 25.
    Dhall, K., & Bagga, R. (1995). Maternal determinants of birth weight of north Indian babies. Indian Journal of Pediatrics, 62(3), 333–344.PubMedCrossRefGoogle Scholar
  26. 26.
    Margetts, B. M., Mohd Yusof, S., Al Dallal, Z., & Jackson, A. A. (2002). Persistence of lower birth weight in second generation South Asian babies born in the United Kingdom. Journal of Epidemiology and Community Health, 56(9), 684–687.PubMedCrossRefGoogle Scholar
  27. 27.
    Hyman, I., & Dussault, G. (1999). Impact of maternal nativity on the prevalence of diabetes during pregnancy among U.S. ethnic groups. Diabetes Care, 22(5), 729–735.CrossRefGoogle Scholar
  28. 28.
    Callister, L. C., & Birkhead, A. (2002). Acculturation and perinatal outcomes in Mexican immigrant childbearing women: An integrative review. The Journal of Perinatal & Neonatal Nursing, 16(3), 22–38.Google Scholar
  29. 29.
    Gfroerer, J. C., & Tan, L. L. (2003). Substance use among foreign-born youths in the United States: Does the length of residence matter? American Journal of Public Health, 93(11), 1892–1895.PubMedCrossRefGoogle Scholar
  30. 30.
    Liem, R., Lim, B. A., & Liem, J. H. (2000). Acculturation and emotion among Asian Americans. Cultural Diversity & Ethnic Minority Psychology, 6(1), 13–31.CrossRefGoogle Scholar
  31. 31.
    Zambrana, R. E., Scrimshaw, S. C., Collins, N., & Dunkel-Schetter, C. (1997). Prenatal health behaviors and psychosocial risk factors in pregnant women of Mexican origin: The role of acculturation. American Journal of Public Health, 87(6), 1022–1026.PubMedGoogle Scholar
  32. 32.
    Dobie, S. A., Baldwin, L. M., Rosenblatt, R. A., Fordyce, M. A., Andrilla, C. H., & Hart, L. G. (1998). How well do birth certificates describe the pregnancies they report? The Washington State experience with low-risk pregnancies. Maternal & Child Health Journal, 2(3), 145–154.CrossRefGoogle Scholar
  33. 33.
    Adams, M. (2001). Validity of birth certificate data for the outcome of the previous pregnancy, Georgia, 1980–1995 [see comment]. American Journal of Epidemiology, 154(10), 883–888.PubMedCrossRefGoogle Scholar
  34. 34.
    Reichman, N. E., & Hade, E. M. (2001). Validation of birth certificate data. A study of women in New Jersey’s HealthStart program. Annals of Epidemiology, 11(3), 186–193.PubMedCrossRefGoogle Scholar
  35. 35.
    Alexander, G. R., Kogan, M. D., Himes, J. H., Mor, J. M., & Goldenberg, R. (1999). Racial differences in birthweight for gestational age and infant mortality in extremely-low-risk US populations. Paediatric and Perinatal Epidemiology, 13(2), 205–217.PubMedCrossRefGoogle Scholar
  36. 36.
    Collins, J. W. Jr., & Martin, C. R. (1998). Relation of traditional risk factors to intrauterine growth retardation among United States-born and foreign-born Mexican Americans in Chicago. Ethnicity & Disease, 8(1), 21–25.Google Scholar
  37. 37.
    de Almeida, M. F., & Jorge, M. H. (1998). Small for gestational age: Risk factor for neonatal mortality. Revista de Saude Publica, 32(3), 217–224.PubMedGoogle Scholar
  38. 38.
    Steward, D. K., & Moser, D. K. (2004). Intrauterine growth retardation in full-term newborn infants with birth weights greater than 2,500 g. Research in Nursing & Health, 27(6), 403–412.CrossRefGoogle Scholar
  39. 39.
    Vandenbosche, R. C., & Kirchner, J. T. (1998). Intrauterine growth retardation. American Family Physician, 58(6):1384–1390, 1393–1394.Google Scholar
  40. 40.
    Parker, J. D., & Schoendorf, K. C. (2002). Implications of cleaning gestational age data. Paediatric and Perinatal Epidemiology, 16(2), 181–187.PubMedCrossRefGoogle Scholar
  41. 41.
    US Department of Health, & Human Services. (2000). Healthy People 2010: Understanding and improving health. Washington, DC: Government Printing Office.Google Scholar
  42. 42.
    Ghosh, C. (2003). Healthy People 2010 and Asian Americans/Pacific Islanders: Defining a baseline of information. American Journal of Public Health, 93(12), 2093–2098.PubMedGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2007

Authors and Affiliations

  • Donald K. Hayes
    • 1
  • Susan L. Lukacs
    • 2
  • Kenneth C. Schoendorf
    • 2
  1. 1.Division of Reproductive HealthCenters for Disease Control & Prevention AtlantaUSA
  2. 2.Office of Analysis, Epidemiology & Health PromotionNational Centers for Health Statistics, Centers for Disease Control & PreventionHyattsvilleUSA

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