BIOST 311
2 June 2017
Final Project: Parity and Low Birth Weight in South African Women
Introduction
Developing countries tend to have high birth rates for a wide variety of reasons. For
instance, having more children in a family means having more sources of income, assuming that
all the children live to an age where they can start working. Another reason for high birth rates
healthcare is not readily available, particularly in rural areas, which means that pregnant women
may not receive the prenatal care they need. Not having proper prenatal care can lead to pregnancy
outcomes like low birth weight and pre-term delivery, among others, but the odds of such outcomes
The scientific question of interest in this analysis asks how a womans parity is associated
with low birth weight for her newborn. The data used is from a cohort study of 755 pregnant South
African women who could not afford private healthcare; the women were followed until childbirth,
at which point the infants birth weights were measured. To examine the association between parity
and low birth weightspecifically, the odds of having a low birth weight infanttwo logistic
regression models were used: the unadjusted model considered parity as the only predictor, while
the adjusted model also included age and smoking status as covariates. The logistic regression
models determined that the association between parity and low birth weight was not statistically
significant.
Methods
In the logistic regression models, the outcome of interest is low birth weight. Low birth
weight is defined as weight below 2500 grams at birth, so the outcome is treated as a binary
variable, with low birth weight = 1 and normal birth weight = 0. The predictor of interest is parity,
The adjusted model includes the covariates of age and smoking status. Age is treated as a
continuous variable, while smoking status is a binary variable, with smokers = 1 and nonsmokers
Age and smoking status were chosen as a confounder and a precision variable, respectively.
Age is a confounder because older women are more likely to have more children, but older women
are also more likely to be in poorer health, leading to pregnancy complications and potentially low
birth weight. Meanwhile, smoking status is a precision variable because it is not associated with
parity, but can similarly cause pregnancy complications and subsequently low birth weight.
Descriptive Statistics
By comparing each variables mean to its median, the distribution of the samplenormal or
skewedcan be determined. For parity, age, and birth weight, the respective means and medians
are within 10% of each other, which suggests that their distributions are all normally distributed.
Meanwhile, for smoking status, the mean and median have a percent difference of 16.8%,
suggesting that the distribution for smoking status is skewed. Since the mean for smoking status
Figure 1: A plot of birth weights, according to parity. The horizontal line is drawn at birth weight
= 2500 g, which is the cutoff for low birth weight.
The plot shows that lower parities tend to have a higher variance in birth weight. Based on
the distribution of birth weights within each parity, all of the parities appear to have a mean birth
weight higher than 2500 g, the cutoff for low birth weight. The lower parities (0 3 prior
deliveries) also have a higher proportion of their infants birth weights under 2500 g as compared
to the higher parities (4 6 prior deliveries), suggesting that mothers of lower parity will have
Results
Unadjusted model:
We do not have sufficient evidence to believe that parity is associated with low birth weight.
Comparing two women differing in parity by one birth, we estimate that the woman with the higher
parity has 13.9% lower odds of having a low birth weight baby than the woman with the lower
parity. Based on a 95% CI, this estimate would not be surprising if the true odds ratio was between
0.682 and 1.09. This association was not statistically significant (p = 0.209).
Adjusted model:
We do not have sufficient evidence to believe that parity is associated with low birth weight.
Comparing two women of the same age and smoking status who differ in parity by one birth, we
estimate that the woman with the higher parity has 6.6% lower odds of having a low birth weight
baby than the woman with the lower parity. Based on a 95% CI, this estimate would not be
surprising if the true odds ratio was between 0.668 and 1.30. This association was not statistically
significant (p = 0.687).
Logistic regression assumes that all observations are independent, and that the predictors
and log odds are linearly associated. When adjusting for the variables of the mothers age and
smoking status, the strength of the association changed, but the statistical significance did not
that is, after adjustment, the association was still not statistically significant, so the conclusions did
not change. A limitation of logistic regression is that it treats the outcome as a binary variable,
which can reduce precision in the results, especially at the cutoff value. For instance, is a 2499 g
infant significantly different than a 2501 g infant? Logistic regression can determine the odds of
having a low birth weight infant, but it cannot determine the exact weight of the infant or how far
away from the cutoff weight the infant is. A different model that could have been used is the
multiple regression model, which would treat birth weight as a continuous variable instead of a
binary variable (low birth weight versus normal birth weight). It would be able to determine the
difference in birth weight between women differing in parity by one birth instead of generalizing
birth weight as either low or normal, as well as estimate the infants birth weights from women of
Conclusions
Based on logistic regression models, we conclude that in South African women, the
association between parity and having a low birth weight infant is not significant. While the
associations showed that the odds of having a low birth weight infant were lower among women
of higher parity, the corresponding p-values were not below 0.05, even after adjusting for the
covariates of age and smoking status. In the adjusted model, smoking status was shown to have
the only significant association with having a low birth weight infant (p = 0.0078). In future
analyses, smoking status as well as other risk factors for low birth weight should be more
thoroughly investigated.
R Code
>pregout$lbw <- 0
>pregout$lbw[pregout$bweight < 2500] <- 1
Unadjusted:
Adjusted: