Abstract
Objective
Comprehensive birth weight analyses of single primiparous infants of Samoan, Caucasian, Chinese, Filipino, Hawaiian/Part Hawaiian, Japanese racial ethnic groups. Sampling of intrauterine growth designed to reflect antecedent intra- and extra-environmental factors and insure uniform racial-ethnic data for any later genetic and phenotypic birth weight modeling.
Study Design
Based upon predetermined relevant gestational age criteria, 121, 197 single primiparous infants birth weight records analyzed. The racial-ethnic basic research paradigms also specified parental diallelic crosses representing intra-and inter-ethnic racial ancestry. Hypotheses tested: 1) the mean birth weight of single primiparous infants of Samoan parentage will be significantly larger than the mean birth weight of similar single primiparous infants of Caucasian, Chinese, Filipino, Hawaiian/Part Hawaiian, and Japanese parentage; 2) mean birth weight of single primiparous infants of only Samoan intra-parentage will be significantly larger than the mean birth weights of single primiparous infants of only Caucasian, Chinese, Filipino, Hawaiian/Part Hawaiian, and Japanese parentage and 3) mean birth weight of single primiparous infants Samoan mothers and non-Samoan fathers will be significantly larger than single primiparous infants of Caucasian, Chinese, Filipino, Hawaiian/ Part Hawaiian, and Japanese mothers and non-Caucasian, non-Chinese, non-Filipino, non-Hawaii/Part Hawaiian and non-Japanese father.
Conclusion
Two of three proposed associated hypotheses adopted: namely, that the mean birth weight of single primiparous infants of one, primary Samoan maternal parentage, and two, of only Samoan maternal and paternal parentage, will be significantly larger than their comparative counterparts. Hypotheses 3 based on Samoan mothers and non-Samoan fathers is tenable, but questionable relative to Caucasian parental background. Research highlights importance of control for potentially confounding variables and assets inherent in independent racial-ethnic cohort investigations.
An immediate demanding basic task in contemporary pediatric research is to identify infant predictors of childhood obesity. Within this perspective birth weight (BW) can be viewed one, as a basic launching platform for plotting the diagnostic development of childhood obesity and two, as an initial target for initiating intervention to control future growth. In line with this prospective disease forecasting strategy is an increased awareness of the role of genomic factors in developing obesity.
Methods
The context for the present research study is focused, namely, to ultimately determine whether BW may be viewed as a predictive stage event in the early pathogenesis of non-syndromic child obesity. Recent studies draw attention to the prevalence of obesity by race-ethnicity (RE) and specifically, to significantly higher rate in Samoans (S).1–5 The substantially higher mean birth weight (MBW) data for Samoan (S) compared to Caucasian (C), Chinese (Ch), Filipino (F), Hawaiiian . part Hawaiian (H) and Japanese (J) RE groups6 are viewed as a potential harbinger of obesity, but require further documentation. Validation based on gestational age (GA) specific analysis must eliminate the primary objection about customary approaches comparing MBWs between diverse populations,7 namely, the impact of underlying antecedent intra- and extra-environmental factors on BW. Measuring antecedent effects conceivably produces a “normal” status between RE BW when comparisons are made across basic covariates. Furthermore, another inherent result ensues if diallelic crosses representing intra- and inter-ethnic ancestry of the studied populations are sampled: the RE group analyses of BW under the proposed new format presumably would insure uniform data sets for any later RE genetic and phenotypic BW modeling.
Fundamentally, this study compares fetal growth curves, based on the MBW of C, Ch, F, H, J and S single primiparous infants (SPI) at specified GA. The RE of each infant is the same as that of the mother. To evaluate parental influence RE is delineated in terms of diallelic crosses;8 that is, parentage from the same intra-ethnic (SI), or different (DI), inter-ethnic ancestry. Specifically, it is hypothesized that (1), the MBWs of SPI of S maternal parentage will be significantly larger than the MBWs of similar SPI infants of C, Ch, F, H, and J parentage; (2), MBWs of SPI of only S parentage will be significantly larger than those of similar SPI infants of only C, Ch, F, H, and J parentage; and (3), MBWs of SPI of S mothers and non-Samoan fathers will be significantly larger than SPI of C, Ch, F, H, and J mothers and non-C, non-Ch, non-F, non-H and non-J father. Resolution of these questions are viewed as fundamental to pursuing other significant related obesity research questions
Analysis
The database for examining factors relative to RE BW were 177,955 State of Hawai‘i birth record files for 1995–2004. Based upon pre-determined relevant inclusion and exclusion criteria, (Appendix A), 121,197 SPI BW records of C, Ch, F, J, H and S parentage, were selected for analysis (Table 1). These SPI birth data, with BWs between 500-5000 grams and gestational age 30–42 weeks were complete files, that is, contained no missing information. In order to avoid institutional, professional and medical attendant level variability, only deliveries that were attended by a Doctor of Medicine in Hospitals of Honolulu County, Hawai‘i were included in the study. As a resume: these files included year of birth, month of birth, infant's gender, GA, mother's age, father's age, mother's education, father's education, marital status of mothers, month gestation in which prenatal care began, prenatal care visits, and maternal gestational weight gain. Accuracy of GA was based on registered ultrasound procedure. Infants records required report of (1) vaginal delivery without complications in labor, and (2) no congenital anomaly or acute health problems, and (3) absence of any listed medical risk factors, including tobacco and alcohol use in mothers. As stated earlier, cases which had missing values on any of these variables were systematically excluded from the study.
Appendix A.
Birth Certificate Data Criteria
| State of Hawai‘i 1995–2004 |
| I. Infant Identity |
| Single primipara (1) |
| Year of birth = 1995–2004 |
| County of Birth = Honolulu |
| Type of facility = Hospital |
| Attendant title = Dr. of Medicine |
| Sex = Male (1) /Female (2) |
| Birth weight = 500–5000 grams |
| No Prenatal Visit ( ) |
| Est. GA = 24–42 weeks |
| APGAR- 1 min = 0–10 |
| APGAR-5 min = 0–10 |
| Mother's race |
| Mother's age (18–70) |
| Caucasian (1)/ Chinese |
| (4) /Filipino (5)/ Hawaiian/Part |
| H (2)/ Japanese (6)/ Samoan (9) |
| Mother's education = non-missing |
| Father's race |
| Fathers age |
| Father's education = non-missing |
| II. Medical risk factors = None |
| 01 Anemia |
| 02 Cardiac disease |
| 03 Lung disease |
| 04 Diabetes |
| 05 Genital herpes |
| 06 Hydramnios/Oligohydramnios |
| 07 Hemoglobinopathy |
| 08 Chrn hypertension |
| 09 Preg hypertension |
| 10 Eclampsia |
| 11 Incmptnt cervix |
| 12 Prv infant 4000+G |
| 13 Prv small infant |
| 14 Renal disease |
| 15 Rh Sensitization |
| 16 Uterine Bleeding |
| 17 Infectious disease |
| 18 Other med risk |
| 19Tobacco use |
| 20 Avg no cig/day |
| 21 Alcohol use |
| 22 Avg no drink/day |
| 23 Pounds gained |
| III. Obstetric procedures: |
| 01 Aminocentesis = No (0) |
| 02 Ectrnc fetal mon = Yes (10 |
| 03 Inductn labor = No (0) |
| 04 Stimulatn labor = No (0) |
| 05 Tocolysis = No (0) |
| 06 Ultrasound = yes (1) |
| 07 Other ob proc = No (0) |
| IV. Deliver methods: |
| 01 Vaginal delivery Yes (1) |
| 02 Vaginal birth > c-section = No (0) |
| 03 Primary c-section = No (0) |
| 04 Repeat c-section = No (0) |
| 05 Forceps = No (0) |
| 06 Vacuum = No (0) |
| V. Comp Labor/Delivery = None (2) |
| 01 Febrile |
| 02 Meconium |
| 03 Prem rupture |
| 04 Abruptio plac |
| 05 Placenta prvia |
| 06 Seizures |
| 07 Precipit labor |
| 08 Prolonged labor |
| 09 Dysfunct labor |
| 10 Breech/Malpres |
| 11 Cephalopelvic |
| 12 Cord prolapsed |
| 13 Anesth complic |
| 14 Fetal distress |
| 15 Other complic |
| VI. Acute prob new-born = None (2) |
| 01 Anemia |
| 02 Birth injury |
| 03 Fetal alc synd |
| 04 Hyaline mem dis |
| 05 meconium aspir |
| 06 Asst vent <30M |
| 07 Asst vent >30M |
| 08 Seizures |
| 09 Oth acute prob |
| VII. Congen anom of child = None (2) |
| 01 Anencephalus |
| 02 Spina bifida |
| 03 Hydrocephalus |
| 04 Microcephalus |
| 05 Other circ anom |
| 06 Resp anom |
| 07 Rectal atresia |
| 08 Tracheo-esoph |
| 09 Omphalocele |
| 10 Other GI anom |
| 11 Maformd gent |
| 12 Renal agenesis |
| 13 Hydrocele |
| 14 Oth urogen anom |
| 15 Cleft lip/pal |
| 16 Polydactyly |
| 17 Club foot |
| 18 Diaphr hernia |
| 19 Oth musculoskl |
| 20 Downs syndrome |
| 21 Oth chrom anom |
| 22 Hemagiona |
| 23 Necus |
| 24 Simian crease |
| 25 Skin tag |
| 26 Oth skin anom |
Table 1.
Distribution of Births based on Maternal and Paternal Race-Ethnicity (MRE/PRE) for 1995-2004 (N=121,197)
| PRE | Caucasian(C) | Hawaiian(H) | Chinese(Ch) | Filipino(F) | Japanese(J) | Samoan(S) | Total | (%) |
| Caucasian(C) | 25899 | 2677 | 847 | 3167 | 2879 | 183 | 35652 | (29.4) |
| Hawaiian/Part Hawaiian(H) | 2892 | 21547 | 646 | 5168 | 3639 | 607 | 34499 | (28.6) |
| Chinese(Ch) | 351 | 538 | 2655 | 356 | 1089 | 35 | 5024 | (24.1) |
| Filipino(F) | 1387 | 4639 | 287 | 17879 | 1711 | 104 | 26007 | (21.4) |
| Japanese(J) | 1075 | 2759 | 998 | 1772 | 8548 | 38 | 15190 | (12.5) |
| Samoan(S) | 225 | 1697 | 38 | 229 | 133 | 2503 | 4825 | (3.9) |
| Total (%) | 31829 | 33857 | 5471 | 28571 | 17999 | 3470 | 121197 | |
| (26.3) | (27.9) | (4.5) | (23.9) | (14.4) | (2.9) |
Statistical Evaluation
All the birth certificate variables except BW, GA and RE of both the mother and father were designated as independent variables. Birth weight was designated as the dependent variable in the subsequent analyses of covariances (ANCOVAs) at each GA. The total sets of designated independent variables were used as covariates for the ANCOVAs at each GA. This step insured that the effects of any variable were consistently taken into account throughout the range of GAs. The ANCOVAs determined whether there were significant differences in MBW among the cohorts at each GA. When necessary GAs were combined or truncated to establish reasonable statistical sample sizes. For example, 37–42 is selected because numbers for the lower GAs are too small, especially for Samoans. Post-hoc Tukey test9 followed only when the main effects were significant.
Results
Table 1 shows the number of first-born singleton births with information on relevant covariates: SPI of C (29.4%) and H (28.6%) women comprise the largest groups; in contrast, Ch (12.5%) and S (3.9%) cohorts were relatively smallest.
Hypothesis 1
Table 2 presents the RE MBW analyses and highlights the significantly larger S maternal parentage BWs relative to those of C, Ch, F, H, and J for the preterm, terms and entire GA range. Appendix B summarizes in detail the result of multiple comparisons on MRE MBW by GA: demonstrating that the SPI BMW data of S parentage are consistently significantly larger.
Table 2.
Racial-Ethnic Birth Weight Comparisons for GAs 24–36, 37–42 and 24–42 1995–2004 (N=121,197)
| GA | Caucasian(C) | Hawaiian(H) | Chinese(Ch) | Filipino(F) | Japanese(J) | Samoan(S) | F | Tukey's Multiple Comparison Testsa |
| 24–36a | 2433.10 | 2422.91 | 2388.68 | 2361.60 | 2386.89 | 2684.98 | F(511184)=14.14*** | S> C, H Ch, F, J |
| n | 2462 | 3236 | 492 | 2985 | 1740 | 275 | ||
| 37–42a | 3500.85 | 3373.40 | 3311.04 | 3230.90 | 3248.08 | 3589.03 | F(5110001)=1367.87*** | S> C, H, Ch, F, J |
| n | 29367 | 30621 | 4979 | 25586 | 16259 | 3195 | ||
| 24–42a | 3418.25 | 3282.55 | 3228.10 | 3140.08 | 3164.82 | 3517.39 | F(5,12191)=1072.22*** | S> C, H, Ch, F, J |
| n | 31829 | 33857 | 5471 | 25871 | 17999 | 3470 |
a*** p< 001
Appendix B.
Multiple Comparisons of Maternal Racial-Ethnic (MRE) Mean Birth Weights (MBW) by Gestational Age (GA) (MRE) 1995–2004 (N=121,197)
| GA | Caucasian(C) | Hawaiian(H) | Chinese(Ch) | Filipino(F) | Japanese(J) | Samoan(S) | F | Tukey's Multiple Comparison testsa |
| 30a | 1560.21 | 1682.87 | 1945.83 | 1545.33 | 1659.96 | 2445 | … | |
| n | 52 | 68 | 6 | 70 | 24 | 7 | ||
| 31a | 1568.49 | 1699.71 | 1528 | 1670.82 | 1559.51 | 2356.5 | … | |
| n | 77 | 92 | 11 | 87 | 43 | 4 | ||
| 33 | 2029.46 | 2069.99 | 2056.58 | 2044.5 | 1954.58 | 2641.95 | S> C, H, Ch, F, J | |
| n | 167 | 211 | 26 | 185 | 113 | 19 | ||
| 34 | 2319.62 | 2313.42 | 2209.02 | 2212.88 | 2212.23 | 2347.92 | ||
| n | 307 | 337 | 63 | 338 | 183 | 36 | ||
| 35 | 2574.66 | 2542.73 | 2404.71 | 2466.01 | 2459.56 | 2811.86 | F(5,2334)=10.48*** | S> C, H, Ch, F, J |
| n | 517 | 659 | 109 | 599 | 413 | 43 | ||
| 36a | 2848.94 | 2814.88 | 2740.58 | 2712.67 | 2672.92 | 2989.64 | F(5,5089)=28.47*** | S> C, H, Ch, F, J |
| n | 1048 | 1477 | 223 | 1376 | 830 | 141 | ||
| 37a | 3064.68 | 3037.16 | 2938.69 | 2931.55 | 2895.48 | 3291.95 | F(5,10758)=74.00*** | S> C, H, Ch, F, J |
| n | 2175 | 3086 | 464 | 3023 | 1771 | 263 | ||
| 38a | 3319.37 | 3239.89 | 3180.26 | 3129.26 | 3129.32 | 3456.54 | F(5,22899)=184.82*** | Ch> F, J S> C, H, Ch, F, J |
| n | 4570 | 6526 | 1040 | 6457 | 3710 | 602 | ||
| 39a | 3470.91 | 3383.19 | 3322.64 | 3269.4 | 3276.09 | 3579.66 | F(5,32737)=290.23*** | Ch> F, J S> C, H, Ch, F, J |
| n | 8016 | 9130 | 1597 | 8104 | 4959 | 937 | ||
| 40a | 3590.91 | 3492.46 | 3436.29 | 3363.17 | 3379.1 | 3693.35 | F(5,31558)=336.04*** | S> C, H, Ch, F, J |
| n | 9385 | 8885 | 1424 | 6312 | 4543 | 1015 | ||
| 41a | 3713.82 | 3625.27 | 3547.31 | 3476.76 | 6507.05 | 3748.02 | F(5,10654)=102.42*** | Ch> F S> C, H, Ch, F, J |
| n | 4439 | 2739 | 423 | 1529 | 1190 | 340 | ||
| 42 | 3775.93 | 3654.62 | 3697.45 | 3468.78 | 3512.23 | 3766.47 | F(5,1365)=16.58*** | H> F S> F, J H,Ch |
| n | 800 | 255 | 31 | 161 | 86 | 38 |
*** p< .001
Hypotheses 2
Distribution of birth for the following intra (N = 1094) -inter (N = 1713) (II) RE MBW comparison are listed in Table 3 based on an N = 1094. Table 4 clearly identifies the analyzed intra-racial ethnic parental group comparisons. The sample truncation of MBW to MGA of 37–42 weeks clearly shows that Samoan MBWs emerge as significantly larger.
Table 3.
Distribution of Births for Intra-Inter (II) RE MBW Comparisons 1995–2004 (N=1094* and N=1713)
| Maternal II RE MBW | |||||||
| Paternal II REMBW | Caucasian | Hawaiian/Part Hawaiian | Chinese | Filipino | Japanese | Samoan | Total |
| Caucasian | 197* | 26 | 17 | 40 | 44 | 1 | 325 |
| Hawaiian/Part Hawaiian | 0 | 252* | 13 | 70 | 61 | 13 | 442 |
| Chinese | 4 | 6 | 101* | 3 | 30 | 0 | 144 |
| Filipino | 11 | 53 | 2 | 288* | 41 | 2 | 397 |
| Japanese | 15 | 28 | 28 | 28 | 231* | 1 | 343 |
| Samoan | 4 | 24 | 0 | 5 | 4 | 25* | 62 |
| Total | 264 | 401 | 161 | 434 | 411 | 42 | 1713 |
Intra-parentage comparison rates ( N=1094)
Table 4.
Mean Intra-racial Birth-weight by Gestational Ages (MBW) (GA) 37–42 1995–2004 (N=1094)
| GA | Caucasian(C) | Hawaiian(H) | Chinese(Ch) | Filipino(F) | Japanese(J) | Samoan(S) | F | Tukey's Multiple Comparison Testsa |
| 37–42 | 3419.57 | 3257.63 | 3237.09 | 3049.02 | 3138.38 | 3558.08 | F(5,1088)=24.74** | S > C, H, Ch, F, J* |
| Total n | 197 | 252 | 101 | 288 | 231 | 25 |
a *p<.05, **p<.01
Hypothesis 3
The multiple sample comparisons on intra-inter maternal/paternal race-ethnicity for GA 37–42 based on the sample truncation of N = 1713 are condensed in Table 5.
Table 5.
Multiple Comparisons of Intra-Inter Racial-Ethnic Mean Birth Weights (IIREMBW) by Gestational Ages (GA) 37–42 for 1995–2004 (N=1713)
| GA IIPMBW | Caucasian(C) | Hawaiian(H) | Chinese(Ch) | Filipino(F) | Japanese(J) | Samoan(S) | F | Tukey's Multiple Comparison Testsa |
| 37–42 IIREMBW | 3402.50 | 3248.37 | 3252.02 | 3094.29 | 3173.53 | 3465.60 | F(5,1707)=23.48*** | S> H, Ch, F, J |
| n | 264 | 401 | 161 | 434 | 411 | 42 |
*** p< .001
Results in Table 5 demonstrate that S maternal parentage was related to significantly larger MBWs in all but the C RE group.
Discussion
As stated earlier, a basic task in contemporary pediatric research is identifying infant predictors of childhood obesity. The research described here insured uniform data across RE groups. This research confirms prior results6 describing RE MBW differences in the State of Hawai‘i: S mothers were documented as delivering infants with larger than average BWs. The RE confirmatory research paradigms investigated parental diallelic crosses representing intra-and inter-ethnic racial ancestry. The results of these contemporary analyses support the adoption of two of three proposed associated hypotheses: namely, (1) that the MBW of SPI of primary S maternal parentage, and (2), of only S maternal and paternal parentage, will be significantly larger than their comparative counterparts. Hypothesis 3 touting larger MBWs based on S mothers and non-S, Ch, F, H and J fathers is tenable for all these RE groups, but questionable for C paternal background and warrants further study.
This study is in line with the earlier stated prospective forecasting strategy viewed as basic to contemporary pediatric research. Results of this present study demonstrate that uniform data sets can be established for comparative and confirming statements on the state of specific factors in the development of a prenatal status condition, namely, MBW associated with the pathogenesis of nonsyndromic childhood obesity. There are other issues associated with this conclusion, which warrant review and incorporation in any planned programmed research, namely:
1. The precise designation of crucial variables, for example, infant birth length required to further contextualize the role of BW, and ultimately, the body mass index (BMI) is not available in any data sets obtained from birth certificates.
2. Adjustments for potential confounding factors. Efforts to equalize statistically internal and environmental factors may not take into account important cultural, behavioral and nutritional factors that can impact on BW.
3. Categorizing a RE group as more likely to have higher BW may point to an implication that RE membership group is the cause. Racial-Ethnic ancestry should not be considered a risk factor for obesity in childhood and later life. Such data are only an opportunity for providing education and intervention for the prevention of obesity to all children, especially those born with high BW independently from RE ancestry. Cultural differences in maternal diet, physical activity and levels of stress, in addition to genetics need to be investigated in well-controlled trials to identify the underlying cause of the differences. An immediate result of concern in this area has led to decisions that sub-group RE differences should be examined separately relative to prenatal outcomes.11 In accord with this viewpoint, the association of faster natal and postnatal growth with childhood BMI has been extensively measured in a single selected cohort.12 Contemporary studies of RE cohorts also have examined whether rapid weight gain between birth and 6 months is linked with childhood overweight and if the risk is correlated with ethnicity and breast-feeding.13
Systematic uniform data sets provide a uniquely devised prenatal growth chart for further studying infant bodily development. They open avenues for research and information on other covariates influencing BW and reaffirm what may be a prime predictor of obesity - BW and changes in BMI over the early months of development.1,10–16
Acknowledgements
Assistance of the Chen Foundation for Medical Research in Pediatrics and the Research and Statistics Office, Department of Health, State of Hawai‘i for birth certificate data is appreciated.
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