Poverty and Birth Defects in Florida: 19962000

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Poverty and Birth Defects in Florida 1996-2000

• Wei Cui, Changxing Ma, Mario Ariet, Michael
  Resnick, Jeff Roth
• Maternal Child Health and Education Research
  and Data Center, Department of Pediatrics,
  College of Medicine, University of Florida

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Background

• Birth defects are known to be the leading cause
  of infant death in the United States.
• Infants of poor mothers have higher rates of
  mortality and morbidity than infants of non-poor
  mothers.
• Poverty effects on birth defects are often
  confounded by factors, such as mothers
  education, race and age at the time of delivery.
  

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Study Question

• Are there differences in birth defects among
  infants of poor and non-poor mothers, after
  adjusting for differences in mothers health and
  sociodemographic characteristics?

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Methods

• The study was based on linked birth vital
  statistics, Birth Defect Registry, and Medicaid
  records for 972,521 livebirths between 1996 and
  2000 in the State of Florida.

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Methods

• Only birth defects detected at the time of birth
  or within the first year of life were considered.
  
• Birth Defect Outcomes investigated
• CDCs Forty-five reported birth defects
• Eight organ system birth defects grouped by
  Florida Birth Defect Registry (FBDR).

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Methods

• Definition of Poverty mothers family income is
  less than 185 of Federal Poverty Level.

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Methods

• Six confounding variables were controlled
• 1. Mothers race (Black White and Other)
• 2. Mothers age (lt20 years 20-34 years and gt34
  years)
• 3. Mothers previous pregnancy experience(0
  failure gt1)

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Methods

• 4. Mothers Education ( ltHS HSgtHS)
• 5. Plurality (Singleton Multiple birth)
• 6. Infants sex (Female Male).

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Statistical Analysis

• Generalized linear models, with the number of
  children having birth defects as the response
  variable were fitted using the GENMOD Procedure
  in SAS.
• Stepwise model selection was employed.
• The adjusted relative risks (RR) and 95
  confidence intervals were estimated.

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Results

• Among 441,205 infants born to poor mothers,
  15,525 (3.5) infants had birth defects
• Among 531,316 infants born to non-poor mothers,
  14,897(2.8) infants had birth defects

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Results
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Results
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Results

• At the organ-system level, infants of poor
  mothers had a significantly higher risk of birth
  defects across the eight organ systems. The three
  organ systems with highest relative risks of
  birth defects in poor infants were Other
  defects(RR 2.2), Central Nervous System (RR
  1.7), and Gastrointestinal System (RR 1.5).

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Results
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Results
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Results
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Results

• At the level of specific birth defect, a
  significantly increased risk was found in 32 out
  of 42 birth defects.

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Results

• The three birth defects with highest relative
  risk associated with poverty were
• Birth Defects associated with maternal alcoholic
  usage during pregnancy (RR 3.2),
• Congenital cataract (RR 2.6),
• Gastroschisis/Omphalocele (RR 2.2).

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Conclusion

• Infants of poor mothers have a higher risk of
  birth defects than infants of non-poor mothers,
  after controlling for differences in maternal
  socio-demographic factors.

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Policy Implications

• The etiology of birth defects associated with
  pregnancy outcomes for poor women needs further
  study.
• Preconceptional education of women in poverty
  potentially could reduce the risk of birth
  defects and subsequently lower infant mortality
  and morbidity.

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Acknowledgments

• The authors thank Jane Correia, Florida
  Department of Health, Bureau of Community
  Environmental Health Jaime Frias, Josefa
  Schlottman, Kimberlea W. Hauser, Birth Defect
  Center, Department of Pediatrics, University of
  South Florida and Li Yan, Maternal Child Health
  and Education Research and Data Center,
  University of Florida, a branch of the Lawton and
  Rhea Chiles Center for Healthy Mothers and
  Babies, for their assistance, cooperation, and
  advice.