SOCIOECONOMIC DETERMINANTS OF INTRAUTERINE GROWTH-RETARDATION

This paper reviews the evidence bearing on socioeconomic determinants of intrauterine growth retardation (IUGR). The primary focus is on tho se factors with a quantitatively important impact from a public health perspective, as indicated by their large etiologic fraction (populati on attributable risk). In developed countries in which a sizeable prop ortion of women smoke during pregnancy, cigarette smoking is associate d with the largest etiologic fraction (by far), followed by low gestat ional weight gain (primarily due to low energy intake) and low prepreg nancy body mass index (BMI). In developing countries where undernutrit ion is prevalent and pregnant women do not smoke, low maternal weight gain and BMI assume even greater importance, as does short maternal st ature. A major section of the paper concerns the large within-country socioeconomic disparities in IUGR and the possible mechanisms underlyi ng these disparities. In developed countries, differences in cigarette smoking explain a large part of the disparity; low weight gain and sh ort stature may also be important mediators in some settings. Future e tiologic studies should assess a wide scope of potential determinants and will require large sample sizes to control for their mutually conf ounding effects.