The Starting Gate provides a thorough and interesting analysis of the relationship between birth weight and health outcomes. Since low birth rate often occurs alongside social stresses, such as minority racial status, low education, young maternal age, low income, etc, it is difficult to identify whether it is biological versus social determinants which lead to the later challenges confronted by low weight babies. Such infants not only experience increased infant mortality rates, but health risks into adulthood. Dalton et al follow the relationship across generations and among social groups that are prone to low birth rates, specifically african americans. One deduction I found interesting (page 86) was when looking at two groups - one high income, the other low - each with a 20% biological predisposition for having low birth weight babies, the wealthier couples had resources to counteract biological odds. With the resources to provide better nutrition and prenatal care, these families managed to shrink the odds of having low weight babies to 4%, compared to the babies of the low income families, who experienced 17% low birth weight.
While I found the book to be a little difficult to digest because a significant portion of the analysis is devoted to picking apart the complex interplay of variables, it does provide some interesting fodder for addressing the issue, especially among populations that are at risk. This is especially significant since the book demonstrates how low birth weight can have far-reaching implications, into the classroom and adulthood. If hospitals and primary health providers carefully educate pregnant women who have predisposition to low weight babies (especially those of low income), it may have very real and positive future outcomes for those babies. Perhaps investing in ensuring that those children do not end up in the 17% low weight statistic listed above will save tax payers down the line in healthcare and other costs.
Another theme I found interesting on pages 74-76 was the implications of stress on social groups, and how pregnant women with elevated stress levels were susceptible to low weight babies. There have been theories that peoples of racial minorities have some sort of discrimination stress. Perhaps a historical decline in low weight babies among women of social minorities may indicate a decrease in social racial discrimination, in a similar manner as trends of interracial marriages?