This research determines whether the observed decline in infant mortality with socioeconomic level, operationalized as maternal education (dichotomized as college or more, versus high school or less), is due to its “indirect” effect (operating through birth weight) and/or to its “direct” effect (independent of birth weight). The data used are the 2001 U.S. national African American, Mexican American, and European American birth cohorts by sex. The analysis explores the birth outcomes of infants undergoing normal and compromised fetal development separately by using covariate density defined mixture of logistic regressions (CDDmlr). Among normal births, mean birth weight increases significantly (by 27–108 g) with higher maternal education. Mortality declines significantly (by a factor of 0.40–0.96) through the direct effect of education. The indirect effect of education among normal births is small but significant in three cohorts. Furthermore, the indirect effect of maternal education tends to increase mortality despite improved birth weight. Among compromised births, education has small and inconsistent effects on birth weight and infant mortality. Overall, our results are consistent with the view that the decrease in infant death by socioeconomic level is not mediated by improved birth weight. Interventions targeting birth weight may not result in lower infant mortality.

BACKGROUND AND PURPOSE: Few investigators have analyzed the fetal cerebral cortex with MR imaging of high magnetic strength. Our purpose was to document the sulcal development and obtain quantitative measurements of the fetal brain in the second trimester.

It has been argued (e.g., the Wilcox-Russell hypothesis) that (low) birth weight is a correlate of adverse birth outcomes but is not on the “causal” pathway to infant mortality. However, the US national policy for reducing infant mortality is to reduce low birth weight. If these theoretical views are correct, lowering the rate of low birth weight may have little effect on infant mortality. In this paper, the authors use the “covariate density defined mixture of logistic regressions” method to formally test the Wilcox-Russell hypothesis that a covariate which influences birth weight, in this case maternal age, can influence infant mortality directly but not indirectly through birth weight. The authors analyze data from 8 populations in New York State (1985–1988). The results indicate that among the populations examined, 1) maternal age significantly influences the birth weight distribution and 2) maternal age also affects infant mortality directly, but 3) the influence of maternal age on the birth weight distribution has little or no effect on infant mortality, because the birth-weight-specific mortality curve shifts accordingly to compensate for changes in the birth weight distribution. These results tend to support the Wilcox-Russell hypothesis for maternal age.

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Birth weight and gestational age are both important predictors of infant survival. Covariate Density Defined mixture of logistic regressions (CDDmlr), a method that accounts for unobserved heterogeneity, has been applied to birth outcomes using birth weight alone. This paper investigates a CDDmlr model of birth outcomes that includes birth weight and gestational age. Applications to four birth cohorts, composed of all non-Hispanic singleton African/European American female/male live births in New York State from 1985-1988, are presented. Multiple birth weight by gestational age optimal (minimal) mortalities are observed in the birth weight by gestational age-specific mortality surface. Multiple optima have not been mentioned in the published literature, but they do appear in some published plots of birth weight by gestational age mortality. It is possible that misreporting of gestational age contributes to this phenomenon, but it cannot completely explain the locations of the local optima. The global optimum is associated with a "normal" fetal development subpopulation, while the local optima are due to a subpopulation that accounts for most low birth weight, intrauterine growth retarded, pre-term, post-term, and small for gestational age births, as well as, births with misestimated gestational ages. These two subpopulations have significantly different birth weight by gestational age-specific mortality surfaces. Consequently, the presence of multiple optima can be attributed to heterogeneity in the birth cohort. Comparisons of CDDmlr based on birth weight by gestational age and birth weight alone might statistically identify births with "erroneous" gestational age.