, Volume 50, Issue 2, pp 615–635 | Cite as

Maternal Education, Birth Weight, and Infant Mortality in the United States

  • Timothy B. Gage
  • Fu Fang
  • Erin O’Neill
  • Greg DiRienzo


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.


Maternal education Birth weight Infant mortality CDDmlr 


  1. Barker, D. J., Bull, A. R., Osmond, C., & Simmonds, S. J. (1990). Fetal and placental size and risk of hypertension in adult life. British Medical Journal, 301, 259–262.CrossRefGoogle Scholar
  2. Basso, O., & Wilcox, A. J. (2009). Intersecting birth weight-specific mortality curves: Solving the riddle. American Journal of Epidemiology, 169, 787–797.CrossRefGoogle Scholar
  3. Basso, O., Wilcox, A. J., & Weinberg, C. (2006). Birth weight and mortality: Causality or confounding? American Journal of Epidemiology, 164, 303–311.CrossRefGoogle Scholar
  4. Buehler, J. W., Kleinman, J. C., Hogue, C. J. R., Strauss, L. T., & Smith, J. C. (1987). Birth weight-specific infant mortality, United States, 1960 and 1980. Public Health Reports, 102, 151–161.Google Scholar
  5. Conley, D., Strully, K. W., & Bennett, N. G. (2003). The starting gate: Birth weight and life chances. Berkeley and Los Angeles: University of California Press.Google Scholar
  6. Din-Dzietham, R., & Hertz-Picciotto, I. (1998). Infant mortality differences between whites and African Americans: The effect of maternal education. American Journal of Public Health, 88, 651–656.CrossRefGoogle Scholar
  7. Frisbie, W. P., Forbes, D., & Pullum, S. G. (1996). Compromised birth outcomes and infant mortality among racial and ethnic groups. Demography, 33, 469–481.CrossRefGoogle Scholar
  8. Fryer, J. G., Hunt, R. G., & Simons, A. M. (1984). Biostatistical considerations: The case for using models. In F. Falkner (Ed.), Prevention of perinatal mortality and morbidity (pp. 9–30). Basel, Switzerland: Karger.Google Scholar
  9. Gage, T. B. (2002). Birth-weight-specific infant and neonatal mortality: Effects of heterogeneity in the birth cohort. Human Biology, 74, 165–184.CrossRefGoogle Scholar
  10. Gage, T. B., Bauer, M. J., Heffner, N., & Stratton, H. (2004). The pediatric paradox: Heterogeneity in the birth cohort. Human Biology, 76, 327–342.CrossRefGoogle Scholar
  11. Gage, T. B., Fang, F., O’Neill, E., & DiRienzo, A. G. (2010). Racial disparities in infant mortality: What has birth weight got to do with it and how large is it? BMC Pregnancy and Childbirth, 10, 86.CrossRefGoogle Scholar
  12. Gage, T. B., Fang, F., O’Neill, E., & Stratton, H. (2009). Maternal age and infant mortality: A test of the Wilcox-Russell hypothesis. American Journal of Epidemiology, 169, 294–303.CrossRefGoogle Scholar
  13. Geneletti, S. (2007). Identifying direct and indirect effects in a non-counterfactual framework. Journal of the Royal Statistical Society, 69, 199–215.CrossRefGoogle Scholar
  14. Gortmaker, S. L. (1979). Poverty and infant mortality in the United States. American Sociological Review, 44, 280–297.CrossRefGoogle Scholar
  15. Gupta, P. D. (1978). A general method of decomposing a difference between two rates into several components. Demography, 15, 99–112.CrossRefGoogle Scholar
  16. Haglund, B., Cnattingius, S., & Nordström, M. L. (1993). Social differences in late fetal death and infant mortality in Sweden 1985–86. Paediatric and Perinatal Epidemiology, 7(1), 33–44.CrossRefGoogle Scholar
  17. Hernández-Diaz, S., Wilcox, A. J., Schisterman, E. F., & Hernán, M. A. (2008). From causal diagrams to birth weight-specific curves of infant mortality. European Journal of Epidemiology, 23, 163–166.CrossRefGoogle Scholar
  18. Hummer, R. A., Biegler, M., DeTurk, P. B., Forbes, D., Frisbie, W. P., Hong, Y., & Pullum, S. G. (1999). Race/ethnicity, nativity, and infant mortality in the United States. Social Forces, 77, 1083–1118.Google Scholar
  19. Institute of Medicine. (1985). Preventing low birthweight. Washington, DC: National Academy Press.Google Scholar
  20. Iván, A. (2002). Perinatal outcomes among Mexican Americans: A review of an epidemiological paradox. Ethnicity & Disease, 12, 480–487.Google Scholar
  21. Kallan, J. E. (1993). Race, intervening variables, and two components of low birth weight. Demography, 30, 489–506.CrossRefGoogle Scholar
  22. Kramer, M. S. (1987). Determinants of low birth weight: Methodological assessment and meta-analysis. Bulletin of the World Health Organization, 65, 663–737.Google Scholar
  23. Lopez-Gonzalez, L., Aravena, V. C., & Hummer, R. A. (2005). Immigrant acculturation, gender and health behavior: A research note. Social Forces, 84, 581–593.CrossRefGoogle Scholar
  24. McCormick, M. C. (1985). The contribution of low birth weight to infant mortality and childhood morbidity. New England Journal of Medicine, 312(2), 82–90.CrossRefGoogle Scholar
  25. Mosely, W. H., & Chen, L. C. (1984). An analytical framework for the study of child survival in developing countries. Population and Development Review, 10(2), 25–45.CrossRefGoogle Scholar
  26. Pearl, J. (2009). Causal inference in statistics: An overview. Statistics Surveys, 3, 96–146.CrossRefGoogle Scholar
  27. Robins, J. M., Hernán, M., & Brumback, B. (2000). Marginal structural models and causal inference in epidemiology. Epidemiology, 11, 550–560.CrossRefGoogle Scholar
  28. Shoham-Yakubovich, I., & Barel, V. (1988). Maternal education as a modifier of the association between low birthweight and infant mortality. International Journal of Epidemiology, 17, 370–377.CrossRefGoogle Scholar
  29. Singh, G. K., & Yu, S. M. (1995). Infant mortality in the United States: Trends, differentials, and projections, 1950 through 2010. American Journal of Public Health, 85, 957–964.CrossRefGoogle Scholar
  30. Solis, P., Pullum, S., & Frisbie, W. (2000). Demographic models of birth outcomes and infant mortality: An alternative measurement approach. Demography, 37, 489–498.CrossRefGoogle Scholar
  31. Su, D. (2005). Body mass index and old-age survival: A comparative study between the Union Army records and the NHANES-I epidemiological follow-up sample. American Journal of Human Biology, 17, 341–354.CrossRefGoogle Scholar
  32. U.S. Department of Health and Human Services. (2000). Healthy people 2010: Understanding and improving health. Washington, DC: U.S. Department of Health and Human Services.Google Scholar
  33. Van Den Oord, E. J. C. G., & Rowe, D. C. (2000). Racial differences in birth health risk: A quantitative genetic approach. Demography, 37, 285–298.CrossRefGoogle Scholar
  34. VanderWeele, T. J. (2009). Marginal structural models for the estimation of direct and indirect effects. Epidemiology, 20, 18–26.CrossRefGoogle Scholar
  35. Waaler, H. T. (1984). Height, weight and mortality: The Norwegian experience. Acta Medica Scandinavica, 215(S679), 1–56.CrossRefGoogle Scholar
  36. Wilcox, A., & Russell, I. (1990). Why small black infants have a lower mortality rate than small white infants: The case for population-specific standards for birth weight. Journal of Pediatrics, 116, 7–10.CrossRefGoogle Scholar
  37. Wise, P. H. (2003). The anatomy of a disparity in infant mortality. Annual Review of Public Health, 24, 341–362.CrossRefGoogle Scholar

Copyright information

© Population Association of America 2012

Authors and Affiliations

  • Timothy B. Gage
    • 1
    • 2
  • Fu Fang
    • 1
  • Erin O’Neill
    • 1
  • Greg DiRienzo
    • 2
  1. 1.AS 114, Department of AnthropologyUniversity at Albany–SUNYAlbanyUSA
  2. 2.Department of Epidemiology and Biostatistics, School of Public HealthUniversity at Albany, State University of New YorkAlbanyUSA

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