Early and Late Preterm Birth Rates Among US-Born Urban Women: The Effect of Men's Lifelong Class Status.

OBJECTIVE: To ascertain the relation of men's lifelong class status (as measured by neighborhood income) to the rates of early (< 34 weeks) and late (34-36 weeks) preterm birth (PTB). METHODS: Stratified and multilevel, multivariable binomial regression analyses were computed on the Illinois transgenerational birth-file of infants (born 1989-1991) and their parents (born 1956-1976) with appended U.S. census income information. The median family income of men's census tract residence at two-time periods were utilized to assess lifelong class status (defined by residence in either the lower or upper half of neighborhood income distribution). RESULTS: In Cook County Illinois, the preterm rate for births (n = 8115) to men with a lifelong lower class status was twice that of births (n = 10,330) to men with a lifelong upper class status: 13% versus 6.0%, RR = 2.2 (2.0, 2.4). This differential was greatest in early PTB rates: 3.9% versus 1.4%, RR = 3.0 (2.5, 3.7). The relation of men's lifelong class status to both PTB components persisted among non-teens, married, college-educated, and non-Latina White women, respectively. The adjusted (controlling for maternal demographic characteristics) RR of early and late PTB for men with a lifelong lower (versus upper) class status were 1.4 (1.1, 1.9) and 1.2 (1.0, 1.4), respectively. The population attributable risk of early PTB for men's lifelong lower class status equaled 16%. CONCLUSIONS: Men's lifelong lower (versus upper) class status is a novel risk factor for early preterm birth regardless of maternal demographic characteristics. This intriguing finding has public health relevance.

Low Birth Weight Among Infants Born to Black Latina Women in the United States.

Objectives To explore associations between race, nativity, and low birth weight (LBW) among Latina and non-Latina women, with special attention to the Black Latina subgroup. Methods Using US natality data from 2011 to 2013, we designed a population-based study to compare LBW (< 2500 g) rates across six groups of women with self-identified race (N = 7,865,264)-White and Black Latina, foreign-born and US-born; non-Latina Black; and non-Latina White-creating 4 models for analysis: unadjusted (Model 1) and adjusted for sociodemographic factors (Model 2), sociodemographic plus medical risk factors (Model 3), and Model 3 factors plus smoking (Model 4). Results Infant LBW rate for Black Latinas (7.9%) was higher than White Latinas (5.6%) and varied by nativity: US-born (8.9%) versus foreign-born (6.1%). Among all study groups, US-born Black Latinas' LBW rate (8.9%) was second only to non-Latina Blacks (11.0%). In unadjusted Model 1, US-born Black Latinas had 81% (odds ratio [OR]: 1.81; 95% confidence interval [CI]: 1.74-1.88) and foreign-born Black Latinas had 22% (OR: 1.22; 95% CI 1.15-1.29) higher odds of LBW than non-Latina White women (reference group). However, in Model 2, ORs for foreign-born Black Latinas were nearly identical to non-Latina Whites (OR: 1.03; 95% CI 0.97-1.1), while US-born Black Latinas' odds were still 47% higher (OR: 1.47; 95% CI 1.42-1.53). Model 3 ORs for each group were similar to Model 2. Conclusions for Practice A significant subgroup of Latina women self-identify as Black, and their LBW rates are higher than White Latinas. Black Latinas born in the United States fare worse than their foreign-born counterparts, implicating negative effects of Black race specific to the US context.

Paternal Lifelong Socioeconomic Position and Low Birth Weight Rates: Relevance to the African-American Women's Birth Outcome Disadvantage.

Objectives To determine the relation of paternal lifelong socioeconomic position (SEP) to the racial disparity in low birth weight (<2500 g, LBW) rates. Methods Stratified and multilevel logistic regression analyses were performed on an Illinois transgenerational dataset of infants (1989-1991) and their parents (1956-1976) with appended U.S. census income data. The neighborhood incomes of father's place of residence at the time of his birth and at the time of his infant's birth were used to measure of lifelong SEP. Population attributable risk (PAR) percentages were calculated to estimate the percentage of LBW infants attributable to paternal low SEP. Results In Cook County, infants (n = 10,168) born to fathers with a lifelong high SEP had a LBW rate of 3.7 %. LBW rates rose among infants born to fathers with early-life (n = 7224), adulthood (n = 2913), or lifelong (n = 7288) low SEP: 5.2, 6.9, and 9.3 %, respectively. The adjusted (controlling for maternal demographic characteristics) OR of LBW for fathers with an early-life, adulthood, or lifelong low (compared to lifelong high) SEP equaled 1.4 (1.2, 1.6), 1.5 (1.3, 1.9), and 2.0 (1.7, 2.3), respectively. The PAR percentages of LBW for paternal low SEP were 40 and 9 % among African-American and White mothers, respectively. Among fathers with a lifelong high SEP, the adjusted OR of LBW for African-American (compared to White) mothers was 1.1 (0.7, 1.7). Conclusions Low paternal SEP is a novel risk factor for infant LBW independent of maternal demographic characteristics. This phenomenon is particularly relevant to the African-American women's birth outcome disadvantage.

The Relation of Neighborhood Income to the Age-Related Patterns of Preterm Birth Among White and African-American Women: The Effect of Cigarette Smoking.

UNLABELLED: Objectives We investigated the contributions of cigarette smoking to the age-related patterns of preterm (<37 weeks) birth (PTB) rates among African-American and White women within the context of lifelong neighborhood income. Methods Stratified and multilevel logistic regression analyses were performed on an Illinois transgenerational dataset of non-Hispanic White and African-American infants (1989-1991) and their mothers (1956-1976) with appended US census income information. RESULTS: Among non-smoking African-American women (n = 20,107) with a lifelong residence in lower income neighborhoods, PTB rates decreased from 18.5 % for teens to 15.0 % for 30-35 year-olds, p < 0.0001. The opposite pattern occurred among African-American women smokers (n = 5936) with a lifelong residence in lower income neighborhoods, p < 0.01. Among upwardly mobile African-American women smokers (n = 756), PTB rates increased from 11.1 % for teens to 24.9 % for 30-35 year-olds, p < 0.05. Cigarette smoking was not associated with an age-related increase in PTB rates among African-American women with a lifelong residence in upper income neighborhoods. No subgroup of White women, even cigarette smokers with a lifelong residence in lower income neighborhoods, exhibited weathering with regard to PTB. Conclusions A weathering pattern of rising PTB rates with advancing age occurs only among African-American women cigarette smokers with an early-life or lifelong residence in lower income neighborhoods, underscoring the public health policy importance of targeted smoking cessation programs in eliminating the racial disparity in the age-related patterns of PTB rates.

Downward economic mobility and preterm birth: an exploratory study of Chicago-born upper class White mothers.

A paucity of published data exists on the factors underlying the relatively poor birth outcome of non-Hispanic White women in the United States. To determine whether downward economic mobility is a risk factor for preterm birth (<37 weeks, PTB) among upper class-born White women. Stratified and multilevel logistic regression analyses were performed on an Illinois transgenerational dataset of non-Hispanic White infants (1989-1991) and their women (1956-1976) with appended US census income information. The study sample was restricted to singleton births of Chicago-born upper-class (defined by early-life residence in affluent neighborhoods) non-Hispanic White women. Upper class-born White women (n = 4,891) who did not experience downward economic mobility by the time of delivery had a PTB rate of 5.4 %. Those women who experienced slight (n = 5,112), moderate (n = 2,158), or extreme (n = 339) downward economic mobility had PTB rates of 6.5, 8.5, and 10.1 %, respectively; RR (95 % CI) = 1.2 (1.0-4.0), 1.6 (1.3-1.9), and 1.9 (1.3-2.6), respectively. Maternal downward economic mobility was also associated with an increased prevalence of biologic, medical, and behavioral risk factors. Interestingly, the relationship between moderate to extreme downward mobility and preterm birth was stronger among former low birth weight (<2500 g, LBW) than non-LBW women: 2.8 (1.4-5.8) versus 1.6 (1.3-1.9), respectively. In multilevel logistic regression models, the adjusted odds ratio of preterm birth for former LBW and non-LBW women who experienced any downward mobility (compared to those women with lifelong upper class status) equaled 2.4 (1.1-5.3) and 1.1 (1.0-1.1), respectively. Downward economic mobility is associated with an increased risk of preterm birth among upper class-born White urban women; this phenomenon is strongest among former low birth weight women.

Small-for-gestational age and preterm birth across generations: a population-based study of Illinois births.

Small for gestational age (weight for gestational age <10th percentile, SGA) and preterm birth (<37 weeks, PTB) are the major determinants of infant mortality rates and racial disparities therein. To determine the generational inheritance patterns of SGA and PTB among non-Hispanic Whites and African-Americans. Stratified and multivariable binominal regression analyses were performed on an Illinois transgenerational dataset of White and African-American infants (1989-1991) and their mothers (1956-1976) with appended US census income information. Former SGA White mothers (N = 8,993) had a twofold greater infant SGA frequency than former non-SGA White mothers (N = 101,312); 14.4 versus 6.9 %, RR = 2.1 (2.0-2.2). Former SGA African American (N = 4,861) mothers had a SGA birth frequency of 25.7 % compared to 16.1 % for former non-SGA mothers (N = 28,090); RR = 1.5 (1.5-1.6). The adjusted (controlling for maternal age, education, marital status, parity, prenatal care usage, cigarette smoking, and hypertension) RR (95 % CI) of infant SGA for former SGA (compared to non-SGA) White and African-American mothers equaled 2.0 (1.9-2.1 and 1.5 (1.5-1.6), respectively. The adjusted RR (95 % CI) of infant preterm birth for former preterm (compared to term) White and African-American mothers were 1.1 (1.0-1.2). The findings were minimally changed among mothers with a lifelong residence in impoverished or affluent neighborhoods. In both races, approximately 8 % of SGA births were attributable to maternal SGA. There is a transgenerational association of SGA but not preterm birth among non-Hispanic Whites and African-Americans. In both races, a similar proportion of SGA births are attributable to maternal SGA.

Black Babies Matter.

Despite dramatic advancements in neonatal intensive care since the 1960s, African-American infants still have more than a two-fold higher first-year mortality rate than non-Latinx White infants. Our essay examines the impact of upstream factors closely linked to the historical and contemporary context of structural racism in the United States on the African-American women's birth outcome disadvantage. In the process, we propose a paradigm to address the racial health inequity in adverse birth outcome by considering the interplay of racism and social class.

African American women's lifetime upward economic mobility and preterm birth: the effect of fetal programming.

OBJECTIVES: We investigated whether African American mothers' upward economic mobility across the life course and having been of low birth weight are associated with the preterm birth of their children. METHODS: We performed stratified and multilevel logistic regression analyses on an Illinois transgenerational data set of African American infants (born 1989-1991) and their mothers (n = 11 265; born 1956-1976) with appended US Census income information. RESULTS: African American mothers with a lifelong residence in impoverished neighborhoods had a preterm birthrate of 18.7%. African American mothers with early life impoverishment who experienced low, modest, or high upward economic mobility by adulthood had lower preterm birthrates of 16.0% (rate ratio [RR] = 0.9; 95% confidence interval [CI] = 0.8, 0.9), 15.2% (RR = 0.8; 95% CI = 0.7, 0.9), and 12.4% (RR = 0.7; 95% CI = 0.6, 0.8), respectively. In multilevel logistic regression models of former low birth weight and non-low birth weight mothers aged 20 to 35 years, the adjusted odds ratio (95% confidence interval) of preterm birth for those who experienced high upward economic mobility (vs those with lifelong impoverishment) was 0.9 (0.5-1.6) and 0.7 (0.5-0.9), respectively. CONCLUSIONS: African American mother's upward economic mobility from early life impoverishment is associated with a decreased risk of preterm birth. However, consistent with fetal programming, this phenomenon fails to occur among mothers born at low birth weight.

Low birth weight across generations: the effect of economic environment.

To determine whether economic environment across generations underlies the association of maternal low birth weight (<2,500 g, LBW) and infant LBW including its preterm (<37 weeks) and intrauterine growth retardation (IUGR) components. Stratified and multilevel logistic regression analyses were performed on an Illinois transgenerational dataset of White and African-American infants (1989-1991) and their mothers (1956-1976) with appended US census income data. Population Attributable Risk percentages were calculated to estimate the percentage of LBW births attributable to maternal LBW. Among Whites, former LBW mothers (N = 651) had an infant LBW rate of 7.1% versus 3.9% for former non-LBW mothers (N = 11,505); RR = 1.8 (1.4-2.5). In multilevel logistic regression models that controlled for economic environment and individual maternal risk factors, the adjusted OR of infant LBW, preterm birth, and intrauterine growth retardation for maternal LBW (compared to non-LBW) equaled 1.8 (1.3-2.5), 1.3 (1.0-1.8), and 1.8 (1.5-2.3), respectively. Among African-Americans, former LBW mothers (N = 3,087) had an infant LBW rate of 19.5% versus 13.3% for former non-LBW mothers (N = 18,558);RR = 1.5 (1.3-1.6). In multilevel logistic models of African-Americans, the adjusted OR of infant LBW, preterm birth, and IUGR for maternal LBW (compared to non-LBW) were 1.6 (1.4-1.8), 1.3 (1.2-1.5), and 1.6 (1.5-1.8), respectively. In both races, approximately five percent of LBW infants with mothers and maternal grandmother who resided in high-income neighborhoods were attributable to maternal LBW. A similar generational transmission of LBW including its component pathways of preterm birth and intrauterine growth retardation occurs in both races independent of economic environment across generations.

African American women's exposure to interpersonal racial discrimination in public settings and preterm birth: the effect of coping behaviors.

OBJECTIVES: To determine whether African American women's coping behaviors modify the relationship between exposure to interpersonal racial discrimination in public settings and preterm birth (<37 weeks). DESIGN: A case-control study was performed among African American women delivering infants at two tertiary care hospitals in Chicago, IL between July 2001-June 2005. A structured questionnaire was administered to measure maternal perceived exposure to interpersonal racial discrimination in public settings and coping behaviors. RESULTS: A greater percentage of African American mothers of preterm infants had high lifetime and past year exposure to racism in public settings than their peers who deliver term infants; odds ratios (OR) and 95% confidence intervals (95% CI) equaled 1.5 (0.9-2.8) for lifetime and 2.5 (1.2-5.2) for past year exposure. Active coping, especially "working harder to prove them wrong" led to attenuated ORs (interaction P value<.05 for lifetime and <.10 for past year. CONCLUSIONS: African American women's exposure to racism in public settings is a risk factor for preterm birth; active coping behaviors weaken this relationship.

Exploring weathering: effects of lifelong economic environment and maternal age on low birth weight, small for gestational age, and preterm birth in African-American and white women.

White women experience their lowest rate of low birth weight (LBW) in their late 20s; the nadir LBW for African-American women is under 20 years with rates rising monotonically thereafter, hypothesized as due to "weathering" or deteriorating health with cumulative disadvantage. Current residential environment affects birth outcomes for all women, but little is known about the impact of early life environment. The authors linked neighborhood income to a transgenerational birth file containing infant and maternal birth data, allowing assessment of economic effects over a woman's life course. African-American women who were born in poorer neighborhoods and were still poor as mothers showed significant weathering with regard to LBW and small for gestational age (SGA) but not preterm birth (PTB). However, African-American women in upper-income areas at both time points had a steady fall in LBW and SGA rate with age, similar to the pattern seen in white women. No group of white women, even those always living in poorer neighborhoods, exhibited weathering with regard to LBW, SGA, or PTB. In contrast, the degree of weathering among African-American women is related to duration of exposure to low-income areas and disappears for those with a life residence in non-poor neighborhoods.

Transgenerational effect of neighborhood poverty on low birth weight among African Americans in Cook County, Illinois.

In perinatal epidemiology, transgenerational risk factors are defined as conditions experienced by one generation that affect the pregnancy outcomes of the next generation. The authors investigated the transgenerational effect of neighborhood poverty on infant birth weight among African Americans. Stratified and multilevel logistic regression analyses were performed on an Illinois transgenerational data set with appended US Census income information. Singleton African-American infants (n = 40,648) born in 1989-1991 were considered index births. The mothers of index infants had been born in 1956-1976. The maternal grandmothers of index infants were identified. Rates of infant low birth weight (<2,500 g) rose as maternal grandmother's residential environment during her pregnancy deteriorated, independently of mother's residential environment during her pregnancy. In a multilevel logistic regression model that accounted for clustering by maternal grandmother's residential environment, the adjusted odds ratio (controlling for mother's age, education, prenatal care, cigarette smoking status, and residential environment) for infant low birth weight for maternal grandmother's residence in a poor neighborhood (compared with an affluent neighborhood) equaled 1.3 (95% confidence interval: 1.1, 1.4). This study suggests that maternal grandmother's exposure to neighborhood poverty during her pregnancy is a risk factor for infant low birth weight among African Americans.

Women's lifelong exposure to neighborhood poverty and low birth weight: a population-based study.

OBJECTIVE: To determine whether women's lifelong residential environment is associated with infant low birth weight. METHODS: We performed race-specific stratified and multivariate binomial regression analyses on an Illinois vital record dataset of non-Latino White and African-American infants (1989-1991) and their mothers (1956-1975) with appended United States census income information. RESULTS: Non-Latino White women (N = 267) with a lifelong residence in low-income neighborhoods had a low birth weight (<2,500 g) incidence of 10.1% vs. 5.1% for White women (N = 10,647) with a lifelong residence in high-income neighborhoods; RR = 2.0 (1.4-2.9). African-American women (N = 18,297) with a lifelong residence in low-income neighborhoods had a low birth weight incidence of 17% vs. 11.7% for African-American women (N = 546) with a lifelong residence in high-income areas; RR = 1.5 (1.2-1.8). The adjusted population attributable risk (PAR) percent of LBW for lifelong residence in low-income neighborhoods was 1.6% for non-Latino White and 23.6% for African-American women. CONCLUSIONS: Non-Latino White and African-American women's lifelong residence in low-income neighborhoods is a risk factor for LBW; however, African-Americans experience a greater public health burden from this phenomenon.

Mortality risk of small infants varies with their mother's birthweight and race.

We analysed a transgenerational linked birth file to investigate the relationship between maternal birthweight and infant birthweight-specific mortality risk for white and African American infants. Birth records of 267,303 infants born between 1989 and 1991 were linked to records of their mothers, born between 1956 and 1976, and to their own death certificates for those dying in the first year. The means, standard deviations and z-scores were calculated for each race- and generation-specific birthweight distribution. Investigators then analysed the mortality of very small infants (birthweight at least two standard deviations below their mean) for three maternal birthweight categories. Over half of the infant deaths involved births with weights more than two standard deviations below the relevant population mean birthweight (comprising 4.2% of white and 6.9% of African American births respectively). African American infants experienced higher mortality rates at all levels of standardised birthweight, from z-scores of -3 to +3. The relative risk of mortality associated with very small infant size was less for infants delivered to smaller birthweight mothers when compared with those whose mothers were average sized or large at birth. This differential effect was confined to neonatal deaths and was more prominent in the white subpopulation.

Preterm birth among African American and white women with a lifelong residence in high-income Chicago neighborhoods: an exploratory study.

OBJECTIVE: To explore the association between race and preterm birth among women with a lifelong residence in high-income neighborhoods. METHODS: Stratified and multivariable logistic regression analyses were performed on the Illinois transgenerational birthfile (infants born 1989-1991 and mothers born 1956-1975) with appended US Census income data. African American (n = 777) and non-Hispanic White (n = 2,327) infants born to mothers with a lifelong residence in Chicago census tracts with median family incomes in the top income quartile were studied. RESULTS: African Americans had a twofold greater preterm (< 37 weeks) birth rate than Whites: 11.6% vs 5.2%, relative risk (95% confidence interval) equaled 2.2 (1.7-2.9). The adjusted (controlling for maternal birth weight, age, education, marital status, cigarette smoking, and prenatal care utilization) odds ratio of preterm birth for African Americans (compared to Whites) equaled 1.2 (.4-2.0). African Americans had a sixfold greater very low birth weight rate (< 1500 g) than Whites: 3.3% vs .6%: relative risk (95% confidence interval) equaled 5.9 (3.1-11.2). The adjusted odds ratio of very low birth weight for African Americans (compared to Whites) equaled 2.4 (1.1-3.9). CONCLUSIONS: A stark racial disparity in the unadjusted rates of preterm birth and very low birth weight exists among women with a lifelong residence in high-income urban neighborhoods; however, the disparity narrows when traditional, individual-level risk factors are mathematically controlled.

Intergenerational birth weights among the direct female descendants of US-born and Mexican-born Mexican-American women in Illinois: an exploratory study.

OBJECTIVE: To explore the intergenerational birth-weight patterns of the direct female descendants of Mexican-American women. DESIGN: This is a population-based study. METHODS: Stratified analyses were performed on a transgenerational dataset of 1956-1975 and 1989-1991 Illinois computerized vital records of Mexican-American infants. RESULTS: Among the descendants of generation 1 US-born Mexican-American women (n=1,940), generation 3 females had a birth weight equivalent to that of their generation 2 mothers, (3294 g vs 3283 g); generation 3 infants with unmarried mothers had a birth weight 121 g less than that of generation 2 infants born to unmarried mothers (3163 g vs 3284 g, P<.01); and generation 3 female infants born to teenaged women had a birth weight 70 g less than that of their generation 2 mothers who were born to teenaged women (3178 g vs 3248 g, P<.01). Among the descendants of generation 1 Mexican-born women (n=1,017), generation 3 females had a birth weight equivalent to that of their generation 2 mothers (3335 g vs 3363 g); generation 3 infants with teenaged mothers had a birth weight 108 g less than that of generation 2 infants with teenaged mothers (3264 g vs 3372 g, P<.01). CONCLUSIONS: An intergenerational rise in birth weight does not occur among the direct female descendants of Mexican-American women.

Pregnancy outcome of Mexican-American women: the effect of generational residence in the United States.

OBJECTIVE: To determine whether duration of generational residence in the United States is associated with the pregnancy outcome of Mexican Americans. DESIGN: This is a population-based study. METHODS: Stratified analyses were performed on a data set of 1989-1991 Illinois computerized vital records of Mexican-American infants. RESULTS: First generation (N=2,203) and second or higher (N=4,192) US-born Mexican-American women had infant low birth-weight rates of 7.5% and 6.1%, respectively, compared to 5.1% for Mexican-born women (N=39,050); relative risk=1.4 (1.2-1.7) and 1.2 (1.1-1.4), respectively. Among women with one or more high-risk sociodemographic characteristics (age less than 20 years, educational attainment less than 12 years, unmarried, high parity, or inadequate prenatal care), first generation (N=1,624) and second or higher generation (N=2,874) US-born Mexican-American women had infant low birth-weight rates of 8.3% and 6.5%, respectively, vs 5.2% for Mexican-born women (N=33,625); relative risk = 1.6 (95% confidence interval [CI], 1.3-1.9) and 1.2 (95% CI, 1.0-1.4), respectively. Among women with the lowest sociodemographic risk profile, infant low birthweight rates did not vary between the subgroups. CONCLUSIONS: For second or higher generation US-born Mexican-American women, the rate of infant low birth weight does not exceed that of first generation US-born women; it actually approximates that of Mexican-born women across a broad range of sociodemographic characteristics.

Classification of acute respiratory disorders of all newborns in a tertiary care center.

OBJECTIVE: To assess the usefulness of current diagnostic criteria in the understanding of neonatal respiratory distress in a tertiary care hospital. METHODS: We prospectively studied 2824 consecutive deliveries to determine the frequency of respiratory disorders of all types. We used definitions based on standard texts, with borderline cases being classified as having the disease in question. RESULTS: Somewhat less than half of all symptomatic infants met textbook criteria for a respiratory diagnosis. Of this subset, the most common diagnosis was respiratory distress syndrome (RDS), followed by transient tachypnea of newborn (TTN), meconium aspiration syndrome (MAS), pneumonia and others. The 323 infants who fit no standard diagnosis all had self-limited conditions similar to TTN. Most (52%) were well in less than 12 hours. Those still symptomatic after 12 hours differed from the definition of TTN by having a clear chest film (38%) and/or by requiring mechanical ventilation (10%). A slight revision of the traditional diagnostic criteria allowed classification of all these cases. CONCLUSION: More than 50% of newborns with acute respiratory symptoms do not fit textbook definitions, even broad definitions which include borderline cases. The concept of TTN should be expanded to include cases with a normal chest film. In addition, we suggest adding the category "transient respiratory insufficiency of the newbom" (TRIN) for babies ventilated briefly but not demonstrably surfactant deficient or infected. This category probably includes infants with many contributing etiologies.

Maternal support in the delivery room and birthweight among African-American women.

OBJECTIVES: We performed a hospital-based case control study of African-American mothers to explore the relationship between maternal support by a significant other in the delivery room and very low birthweight (VLBW). METHODS: We administered a structured questionnaire to mothers of VLBW (less than 1,500 g; N=104) and normal birthweight (greater or equal to 2,500 g; N=208) infants. RESULTS: The odds ratio for VLBW comparing women without social support in the delivery room to those with a companion was 3.5 (2.1-5.8). Several traditional risk factors were not associated with VLBW, but older maternal age and perceived racial discrimination were. CONCLUSIONS: Maternal support in the delivery room or factors closely associated with it significantly decreases the odds of delivering a VLBW infant for African-American women.