The “Latina Epidemiologic Paradox” Revisited: The Role of Birthplace and Acculturation in Predicting Infant Low Birth Weight for Latinas in Los Angeles, CA

The “Latina epidemiologic paradox” refers to the observation that despite socioeconomic disadvantages, Latina mothers in the
United States (US) have a similar or lower risk for delivering an infant with low birth weight (LBW) compared to non-Latina
White mothers. An analogous paradox may exist between foreign-born (FB) and US-born (USB) Latinas. Our goal was to assess
differences in LBW in USB Latinas, FB Latinas, and non-Latina Whites in Los Angeles County in 2003 using birth records and
survey data. Using logistic regression, we estimated associations between LBW and birthplace/ethnicity in a birth cohort and
nested survey responder group and between LBW and acculturation in responders to a follow-up survey. USB Latinas and FB Latinas
had a higher prevalence of LBW infants compared to Whites (odds ratio [OR] = 1.34, 95% confidence interval [CI] = (1.17, 1.53)
and OR = 1.32, 95% CI = (1.18, 1.49), respectively); when we adjusted for additional maternal risk factors these point estimates
were attenuated, and interval estimates were consistent with a modest positive or inverse association. Among Latinas only,
LBW was more common for high-acculturated FB and USB Latinas compared to low-acculturated FB Latinas, and there was limited
evidence that environmental or behavior risk factors had less impact in low-acculturated Latinas. In summary, adjusting only
for demographics, Latinas in our study were more likely to have LBW infants compared to Whites, in contrast to the Latina
paradox hypothesis. Furthermore, adjusting for environmental or behavioral factors attenuated the positive association, but
there was little evidence that Latinas had a lower prevalence of LBW regardless of the variables included in the models. Finally,
among Latinas, there was limited evidence that associations between known risk factors and LBW were modified by acculturation.