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In the state of Hawaii, Samoan mothers are known for the large average birthweight and low percentage of low birthweight (< 2500 g) of their infants, in spite of the relatively low socio-economic status of the population. This paper reports the findings of a temporal trend analysis of birth outcomes of Samoan women and identifies worrying changes. Data were obtained from Hawaii birth certificates. Single live births to Hawaii-resident Samoan and Caucasian women from 1979 to 1994 were included in the study. Infants of Samoan women experienced a 75 g decline in mean birthweight and an increase in the percentage of low (< 2500 g) and very low (< 1500 g) birthweight from 2.6 and 0.4 to 3.8 and 0.8 respectively. During the same time, infants of Caucasian mothers experienced an increase in mean birthweight and a decline in low birthweight, while very low birthweight did not change. Maternal socio-demographic characteristics explained only part of the findings and use of prenatal care did not appear to be associated with any birth outcome indicators. Multiple regression analyses identified an adjusted loss of 50.8 g in birthweight and a 1.48 increase in the odds ratio of small-for-gestational-age associated with birth at the end (1991-4) compared with the beginning (1979-82) of the study period. Further studies focusing on maternal health status and psycho-social variables, including the effect of acculturation-related stress, are warranted to identify at least some of the determinants of the changes identified by this analysis.

This study examined the impact of maternal diabetes on birth weight for gestational age patterns of all term black infants and white infants in the United States using data derived from the 1990-1991 US Live Birth File of the National Center for Health Statistics. Infants of both black mothers and white mothers exhibited the expected fetal overgrowth associated with maternal diabetes. However, the increase in birth weight was much greater in infants of black than white diabetic mothers in comparison with their nondiabetic counterparts, as measured by the discrepancy in birth weight between infants of diabetic and nondiabetic mothers at each gestational week, the incidence of large for gestational age, high birth weight, small for gestational age, and low birth weight. After adjustment for maternal hypertension, prenatal care use, and sociodemographic factors, the disparity in mean birth weight associated with diabetes was 211.67 g in black infants and 115.74 g in white infants. The adjusted odds ratios of birth weight > or = 4,000 g were 2.98 (95% confidence interval 2.89-3.12) for black infants and 1.83 (95% confidence interval 1.78-1.89) for white infants. Given the potential risks for mothers and infants consequent to maternal diabetes and fetal hyperinsulinemia, further investigation of the prevalence, characteristics, and outcomes of diabetes during pregnancy among black mothers and infants is warranted.

This paper examines changes in maternal sociodemographic characteristics and pregnancy outcomes in Hawaii during the period 1979-1994. The more striking changes were increases of 129% in the proportion of births to women > 35 years old and of 67% in the proportion of births to unmarried mothers. The percentage of low birth weight and small-for-gestational age infants decreased while the proportion of premature births increased. Identified changes were not limited to selected population groups, but were found in various degrees in all ethnic groups. These findings are relevant to all health practitioners and will assist in the provision of appropriate care and counseling to individual women.

Objectives: This study investigated the birth outcomes of Japanese Americans, focusing on the role of the mother's place of birth., Methods: Single live births to US-resident Japanese American mothers (n = 37,941) were selected from the 1983 through 1987 US linked live birth-infant death files., Results: US-born mothers were more likely than foreign-born mothers to be less than 18 years old and not married, to start prenatal care early, and to more adequately use prenatal care. Infants of foreign-born Japanese Americans had a slightly lower risk of low birthweight.No significant differences were found between nativity groups for very low birthweight or neonatal, postneonatal, and infant mortality. The mortality rates of infants of US-born (6.2) and foreign-born (5.4) Japanese American women were below the US Year 2000 objective but still exceeded Japan's 1990 rate (4.6). However, low-birthweight percentages of the US-born group (5.7%) and the foreign-born group (5.0%) were similar to that of Japan (5.5%)., Conclusions: The infants of foreign-born Japanese-American women exhibited modestly better low-birthweight percentages than those of US-born Japanese Americans. This finding supports theories of the healthy immigrant.

Percentages of low birth weight are low in American Indian and Mexican-American populations despite a high prevalence of traditional risk factors. Data derived from 1979-1990 Hawaii vital record files were used to examine birth weight, infant mortality, and their correlates in Samoan and Hawaiian residents of Hawaii to assess whether traditional risk factors are adequate predictors of low birth weight and whether low birth weight is an adequate measure of infant mortality risk in Polynesian populations. Despite very low educational attainment, high proportions of unmarried status, and inadequate prenatal care use, low and very low birth weight percentages were less than the US average. High birth weight was common. Unmarried status and primiparity after age 17 increased low birth weight risk, while high educational attainment and Samoan ethnicity decreased the risk. Adequate prenatal care was not associated with reduced low birth weight risk. Higher than expected neonatal mortality, particularly among normal birth weight infants, and high postneonatal mortality among Hawaiian infants suggest that poverty and maternal chronic disease, rather than low birth weight, may be the primary mediators of infant mortality risk in some populations. The need for clearer specification of risk factors and caution in generalized risk assessment in diverse populations is emphasized.

This study compares the maternal sociodemographic and prenatal care characteristics and birth outcomes of US resident white and Japanese-American mothers, using data from the state of Hawaii. The specific focus is to determine to what extent these factors can explain variations in newborn maturity and mortality indicators. Single livebirths to resident, non-military dependent white and Japanese-American mothers were selected for analysis from the 1979-1990 linked livebirth-infant death files from Hawaii. Compared with white mothers, Japanese-American mothers were significantly more likely to be married, age 18 years and older, have higher educational attainment, and have adequate prenatal care utilisation. The majority of Japanese-American mothers were born in Hawaii, while the majority of white mothers were born on the US mainland. The mean birthweight of Japanese-American infants was 200 g lighter than that of white infants. Infant mortality rates (IMRs) for both groups were below the US Year 2000 Health Objective. After controlling for maternal sociodemographic and prenatal care factors with logistic regression, Japanese-American infants had significantly higher risks of low birthweight, preterm and very preterm birth and of being small-for-gestational age. These findings indicate that populations with preferential maternal sociodemographic and prenatal care risk indicators may still exhibit higher low birthweight percentages, but achieve comparatively low IMRs.

Objectives: We examined the pregnancy outcomes of three ethnic groups: African-American Blacks, non-Hispanic Whites, and Filipinos. In an attempt to reduce ethnic dissimilarities in parental employment and access to health care, this investigation compared the single-live-birth outcomes of married, adult women who resided in the state of Hawaii and who indicated that their spouse was on active-duty status in the US military., Methods: The data for this study were obtained from the 1979-1989 Hawaii vital-record file that provides linked live birth-infant death information. Multiple logistic regression was used to calculate odds ratios for the independent effects of maternal factors on low birthweight and neonatal mortality., Results: Significant differences in maternal age, maternal education, paternal education, parity, hospital of delivery, and use of prenatal care were observed among the ethnic groups. The results of a logistic regression analysis of low birthweight indicated significantly higher risks for Filipinos and Blacks compared with Whites. For very low birthweight, only an increased risk for Blacks was observed. No ethnic differences in neonatal mortality were found., Conclusions: This investigation revealed more comparable infant mortality experiences among the ethnic groups in spite of persistent birthweight differences.

Since the end of the Korean War, immigration of Koreans to the United States has increased rapidly. In 1990, 11.6 percent of all Asians in the United States were of Korean ethnicity, and it is projected that Koreans will outnumber all other Asian groups, except Filipinos, in the United States by the year 2030. Despite the growing size of this population, very little is known about their health status. This study, using 1979-89 Hawaii vital record data, investigates the relationship between maternal sociodemographic characteristics, prenatal care utilization factors, and birth outcomes among Koreans as compared with Caucasians. The ethnic term "Caucasian" is used in Hawaii's vital records and is synonymous with non-Hispanic whites. Korean mothers were more likely to be older and have lower educational attainment, and less likely to be adolescent, single, or to have received adequate prenatal care than Caucasian mothers. More than 80 percent of the Korean mothers were foreign born. Significantly higher risks for very preterm delivery (less than 33 weeks) and very low birth weight births were observed for Koreans as compared with Caucasians. Nativity had no effect on birth outcome in this population. The results of this study suggest that prevention of preterm birth is an important focus for improving pregnancy outcomes in this growing ethnic group.