Pregnancy outcomes of Pacific islanders in Hawaii

Percentages of low birth weight are low in American Indian and Mexican-American populations despite a high prevalence of traditional risk factors. Data derived from 1979-1990 Hawaii vital record files were used to examine birth weight, infant mortality, and their correlates in Samoan and Hawaiian residents of Hawaii to assess whether traditional risk factors are adequate predictors of low birth weight and whether low birth weight is an adequate measure of infant mortality risk in Polynesian populations. Despite very low educational attainment, high proportions of unmarried status, and inadequate prenatal care use, low and very low birth weight percentages were less than the US average. High birth weight was common. Unmarried status and primiparity after age 17 increased low birth weight risk, while high educational attainment and Samoan ethnicity decreased the risk. Adequate prenatal care was not associated with reduced low birth weight risk. Higher than expected neonatal mortality, particularly among normal birth weight infants, and high postneonatal mortality among Hawaiian infants suggest that poverty and maternal chronic disease, rather than low birth weight, may be the primary mediators of infant mortality risk in some populations. The need for clearer specification of risk factors and caution in generalized risk assessment in diverse populations is emphasized.