The principal purpose of this research was to develop profiles of risk for low birth weight (LBW), small for gestational age (SGA), and prematurity among infants of Appalachian Ohio teenagers. Known risk factors for LBW-related outcomes in teen pregnancy were organized into a theoretical model for the natural history of low birth weight. Risk factors mutable early in the natural history of low birth weight were identified for their specific association with LBW, SGA, and prematurity in the Appalachian Ohio teen population.

Birth certificates of all 2961 live, singleton infants born in 1989 to teens in the Appalachian Ohio counties were examined. All known risk factors for LBW in teen pregnancy were screened in bivariate analyses for association with LBW, SGA and prematurity. Multiple logistic regression was used to estimate the effects of the risk factors for each outcome.

Risks from the early stages in the theoretical history of low birth weight associated by multivariate analysis with LBW in infants of Appalachian Ohio teens were limited to: previous LBW infant, low pre-pregnancy weight, low parity, low weight gain, cigarette smoking, and vaginal bleeding. The multiple logistic regression model for SGA risk included: previous LBW infant, low pre-pregnancy weight, low weight gain, cigarette smoking, and high blood pressure; infant sex, added as a control factor, was retained in the model. Only the following risks were associated in multivariate analysis with prematurity: previous LBW infant, low pre-pregnancy weight, adequacy of prenatal care, high blood pressure, and vaginal bleeding.

The stability of risk factor profiles for each outcome were tested in the Appalachian Ohio teen population using data from a subsequent year. The direction and magnitude of the odds ratios for the risk factors in each model were similar, with comparable confidence intervals.

Risks profiles for Appalachian Ohio teens were compared with the white and African American teen mothers residing in the two nearest metropolitan counties. Possible differences in etiological development of SGA and prematurity were discussed. The usefulness of the validated risk factor profiles for planning primary and secondary interventions among teens in the Appalachian Ohio region was described.