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Preconceptional factors associated with very low birthweight delivery in East and West Berlin: a case control study
Ingrid Grimmer1, Christoph Bührer, Joachim W Dudenhausen
1Department of Neonatology, Charité Virchow Hospital; Humboldt University, Berlin, Germany. christoph.buehrer@charite.de
Insights
Very low birthweight (VLBW) risk factors differ between East and West Berlin, influenced by socioeconomic status and maternal history. Political context significantly impacts the VLBW risk profile.
Area of Science:
- Perinatal epidemiology
- Public health
- Sociology of health
Background:
- Very low birthweight (<1500g) is a major cause of infant mortality and morbidity.
- Understanding VLBW causes and risk factors is crucial for prevention.
- Sociodemographic factors are linked to preterm birth, but their impact on VLBW is less understood.
Purpose of the Study:
- To compare preconceptional risk factors for very low birthweight delivery.
- To investigate differences between East and West Berlin post-unification.
- To analyze the influence of sociodemographic and obstetrical history on VLBW.
Main Methods:
- Case-control study design.
- Recruitment of VLBW infants and controls in East and West Berlin.
- Multivariate logistic regression analysis of parental covariates and regional differences.
Main Results:
- Significant risk factors for VLBW included short maternal education, unemployment, poor housing, smoking, prior preterm birth, and fetal loss.
- Living in West Berlin modified the risk for single mothers.
- Regional differences in risk factor prevalence and impact were observed.
Conclusions:
- Very low birthweight is associated with distinct obstetrical history and socioeconomic indicators in East and West Berlin.
- The political and social environment influences the hierarchy of VLBW risk factors.
Background:
Very low birthweight, i.e. a birthweight < 1500 g, is among the strongest determinants of infant mortality and childhood morbidity. To develop primary prevention approaches to VLBW birth and its sequelae, information is needed on the causes of preterm birth, their personal and social antecedents, and on conditions associated with very low birthweight. Despite the growing body of evidence linking sociodemographic variables with preterm delivery, little is known as to how this may be extrapolated to the risk of very low birthweight.
Methods:
In 1992, two years after the German unification, we started to recruit two cohorts of very low birthweight infants and controls in East and West Berlin for a long-term neurodevelopmental study. The present analysis was undertaken to compare potential preconceptional risk factors for very low birthweight delivery in a case-control design including 166 mothers (82 East vs. 84 West Berlin) with very low birthweight delivery and 341 control mothers (166 East vs. 175 West).
Results:
Multivariate logistic regression analysis was used to assess the effects of various dichotomous parental covariates and their interaction with living in East or West Berlin. After backward variable selection, short maternal school education, maternal unemployment, single-room apartment, smoking, previous preterm delivery, and fetal loss emerged as significant main effect variables, together with living in West Berlin as positive effect modificator for single-mother status.
Conclusion:
Very low birthweight has been differentially associated with obstetrical history and indicators of maternal socioeconomic status in East and West Berlin. The ranking of these risk factors is under the influence of the political framework.