MULTIPLE FACTORS AS MEDIATORS OF THE REDUCED INCIDENCE OF LOW-BIRTH-WEIGHT IN AN URBAN CLINIC POPULATION

A five year prospective observational study was initiated in 1985 at H oward University to describe the nutritional, clinical, dietary, lifes tyle, environmental, and socioeconomic characteristics of women who en rolled in the hospital prenatal clinic. The participants were nullipar ous, between the ages of 18 and 35 years, free of diabetes and abnorma l hemoglobins (sickle cell disease, thalassemia, and hemoglobin C), an d had been admitted prior to the 29th week of gestation. During the th ree year period from 1985-1988, the incidence of low birth weight (LBW ) in 239 deliveries to project participants was 8.3%, whereas that of women simultaneously enrolled in the prenatal clinic with the same eli gibility requirements, but not recruited for the research project, was 21.9% (P=0.001). The incidence of LBW in infants of African American women with these eligibility requirements who were delivered by privat e physicians but were not enrolled in the project, was 6.3% The reduct ion in LBW of infants delivered to participants in this study is attri buted to the enhanced social and psychological support by project staf f during their pregnancies. The caring, sensitive demeanor of the rese arch project staff may have empowered the participants to (a) give gre ater compliance (91 vs. 70%) in the ingestion of the routine physician -prescribed vitamin/mineral supplement, which provided nutrients low ( less than 70% of the 1989 RDAs) in their customary diets, such as fola te, pyridoxine, iron, zinc, and magnesium and (b) show greater account ability in keeping prenatal clinic appointments. It is hypothesized th at the enhanced social support resulted in stress reduction and stimul ation of immunocompetence in these low income women.