Department of Applied Health Science, School of Public Health, Indiana University, Bloomington, Indiana.
Department of Epidemiology and Biostatistics, School of Public Health, Indiana University, Bloomington, Indiana.
Womens Health Issues. 2014 Mar-Apr;24(2):e251-6. doi: 10.1016/j.whi.2014.01.001. Epub 2014 Feb 16.
Low birth weight outcomes result from multiple potential risks. The present study used latent class analysis to identify subgroups of women with multiple co-occurring risks and to examine the relationship of these risk classes to low birth weight outcome.
Data were analyzed on all live singleton births in 2010 and 2011 in West Virginia (N = 28,820). Ten risks were examined including marital status, stress, mother's age, parity status, reported smoking and drug use during pregnancy, delayed prenatal care, Medicaid coverage, uninsurance, and low education.
Six latent classes were identified that ranged from a low-risk referent group to higher risk classes characterized by unique constellations of risk factors. Compared with the low-risk referent, all of the remaining five latent classes were significantly associated with increased odds of low birth weight. However, one class was at especially high risk; this class was characterized by unmarried women in the Medicaid program who reported drug use, smoking, stress, and late prenatal care (odds ratio, 4.78; 95% confidence interval, 4.07-5.61).
The person-centered approach identified subgroups of women with unique risk profiles. The results suggest that eliminating a single risk would not resolve the low birth weight problem. Smoking, for example, co-occurs with higher stress and higher levels of drug use among a Medicaid population. It may be beneficial to develop and test tailored interventions to groups with specific co-occurring risks to reduce low birth weight outcomes. Programs targeted to women in the Medicaid program who also engage in substance use and experience stress are especially indicated.
低出生体重的结果源于多种潜在风险。本研究使用潜在类别分析来识别具有多种共同风险的女性亚组，并研究这些风险类别与低出生体重结局的关系。
对 2010 年和 2011 年西弗吉尼亚州所有活产单胎的出生数据进行了分析（N=28820）。共考察了 10 种风险，包括婚姻状况、压力、母亲年龄、产次、报告怀孕期间吸烟和吸毒、产前保健延迟、医疗补助覆盖、无保险和低教育程度。
确定了六个潜在类别，从低风险参照组到高风险组，每个风险组的特征是独特的风险因素组合。与低风险参照组相比，其余五个潜在类别均与低出生体重的风险增加显著相关。然而，有一个类别风险特别高；这个类别特征是参加医疗补助计划的未婚妇女报告吸毒、吸烟、压力大和产前保健延迟（优势比，4.78；95%置信区间，4.07-5.61）。
以个体为中心的方法确定了具有独特风险特征的女性亚组。结果表明，消除单一风险并不能解决低出生体重问题。例如，吸烟与医疗补助人群中更高的压力和更高水平的吸毒行为同时发生。针对具有特定共同风险的群体制定和测试针对性干预措施可能有助于降低低出生体重结局，针对同时使用药物和经历压力的医疗补助计划中的妇女的项目尤其具有针对性。
