Crain_Kayla_Research_Paper

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NC BIRTHS RESEARCH REPORT DATA SET By KAYLA CRAIN STAT 535 INDIANA WESLEYAN UNIVERSITY DECEMBER 2023

NC BIRTHS RESEARCH REPORT DATA SET 1 Contents PROJECT BACKGROUND ........................................................................................................... 2 Purpose of the Study .................................................................................................................... 2 Context of the Problem, Challenge Opportunity or Issue ........................................................ 2 Objectives of the Study ............................................................................................................ 2 Limitations of the Study .......................................................................................................... 2 Assumptions of the Study ........................................................................................................ 3 Significance of the Study ............................................................................................................. 4 What are the goals of the Study ............................................................................................... 4 Significance of the Topic to the Writer .................................................................................... 4 Significance of the Topic to Stakeholders ............................................................................... 4 Broader Implications of the Topic ........................................................................................... 5 INFORMATION and LITERATURE REVIEW ............................................................................. 5 Brief Summary of the Literature on the Subject .......................................................................... 5 Systematic Review of the Literature ............................................................................................ 6 Descriptive Statistics ................................................................................................................... 7 Descriptive Graphs .................................................................................................................... 10 PROJECT ANALYSIS .................................................................................................................. 18 Analysis of the Literature Review Research Findings .............................................................. 18 Simple Linear Regression Analysis ....................................................................................... 18 Single Sample Hypothesis Test of the Mean ......................................................................... 18 Chi-Square Analysis .............................................................................................................. 18 PROJECT SUMMARY ................................................................................................................. 20 Conclusions ................................................................................................................................ 20 Specific Recommendations ....................................................................................................... 20 Suggestions for Future Research ............................................................................................... 20 References ...................................................................................................................................... 21 Appendices .................................................................................................................................... 24 Appendix A: Data Set ................................................................................................................ 24 Appendix B: Pictures of Analysis .............................................................................................. 25

NC BIRTHS RESEARCH REPORT DATA SET 2 PROJECT BACKGROUND Purpose of the Study Context of the Problem, Challenge Opportunity or Issue The birth weight of a baby is the first weight recorded shortly after birth, usually within a few hours, before any significant weight loss occurs. The World Health Organization (WHO) defines low birth weight (LBW) as a birth weight less than 2500 g (or 2499 g and below). This LBW definition has been in existence for many years (Cutland, 2017, Para 2). In pounds, 2500 grams is equivalent to 5.51 pounds, and 2499 grams is equal to 5.50 pounds. There is a worldwide issue regarding education on low birth weight, and it is crucial that we dedicate time to researching and analyzing the low birth weight rate problem. Objectives of the Study In this research paper, the aim is to provide information about the challenges and context surrounding a study conducted in 2004, which found that 11% of births were low-birth-weight. It is important to note that preterm birth and being small for gestational age are significant factors contributing to low birth weight, and they also indirectly lead to neonatal deaths. In fact, low birth weight accounts for 60% to 80% of all neonatal deaths. The global prevalence of low birth weight is estimated to be 15.5%, which means approximately 20 million infants are born with low birth weight annually, with 96.5% of these cases occurring in developing countries (World Health Organization, 2018, Para 3). Consequently, the objective of this study is to analyze strategies for preventing the occurrence of low birth weight babies, aiming to ultimately reduce the global rate of low birth weight. Limitations of the Study

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NC BIRTHS RESEARCH REPORT DATA SET 3 The limitations of this study consist of a small sample size, with only 1000 people included. Additionally, the length of time the study took place is a limiting factor, as it was completed within a year. This limited timeframe restricts the ability to study factors such as economic stress, as it was conducted in 2004, before the financial crisis of 2009. Stressful events have been suggested as potential contributors to preterm birth and low birth weight. However, this study does not provide information on whether a financial crisis caused low birth weight due to stress (Eiriksdottir, 2013, Para 1). Furthermore, the study lacks information on whether the mothers had chronic health conditions that could lead to low birth weight, such as high blood pressure, diabetes, and heart, lung, or kidney problems (March of Dimes, 2020, Para 7). The study also does not contain information on the relationship status of unmarried mothers, whether they are in a committed relationship or underwent pregnancy alone. Additionally, the study does not address whether prenatal vitamins could be a cause of low birth weight. Another limitation is the lack of information on whether a lack of doctors offering prenatal care could cause distress for both the mother and the baby. Assumptions of the Study The study assumes that the factors collected in 2004, such as age, lack of maternal care, being a single mother, etc., are the causes of low birth weight. Additionally, it assumes that the accuracy of this information is correct. The presence of gaps in the data is attributed to privacy concerns.

NC BIRTHS RESEARCH REPORT DATA SET 4 Significance of the Study What are the goals of the Study The aims of this study are to examine the collected data to gain understanding on strategies for avoiding low birth weight (LBW). The factors considered include age, duration of pregnancy, frequency of doctor visits, marital status, weight gain, correlation between baby's weight and gender, maternal smoking, and race. Conducting the analysis will foster meaningful connections and offer valuable insights aimed at preventing LBW infants in the United States and other nations. Significance of the Topic to the Writer This writer holds personal importance in offering valuable insights that assist co-workers, friends, family, and loved ones in ensuring the birth of healthy babies. Being able to provide concrete evidence through specific actions is a crucial aspect for this writer. Significance of the Topic to Stakeholders Health organizations could benefit from offering improved scholarships for education, as this would help address the significance of providing proper healthcare for pregnant women to the stakeholders. By recruiting medical students to specialize as OB-GYNs, more newly trained obstetrician-gynecologists (OB-GYNs) would be available to provide care for individuals in need and open practices in underserved areas. This is particularly important considering that half of U.S. counties lack a single OB-GYN, putting the lives of many women at risk who require essential care. The American College of Obstetricians and Gynecologists (ACOG) highlighted in a 2017 report that these areas house more than 10 million women who may require OB-GYNs for primary care (Marsa, 2018, Para 4).

NC BIRTHS RESEARCH REPORT DATA SET 5 Broader Implications of the Topic Industry implications. The healthcare sector plays a crucial role in offering assistance to women and infants who require care. Bringing new healthcare facilities to areas with limited access to care can be beneficial. It not only proves advantageous for healthcare providers but also for the local communities. When residents feel secure with their immediate healthcare options, they are more likely to stay and not relocate elsewhere. Global implications. If we fail to continue providing essential data globally, the consequences could include an increase in the number of low weight births. The writer's objective is to highlight various factors and research that can contribute to solutions worldwide. Despite significant differences in insurance systems across countries, low birth rates remain a problem in many regions. By raising awareness about this issue, more countries will be motivated to conduct research and offer necessary care solutions. INFORMATION and LITERATURE REVIEW Brief Summary of the Literature on the Subject March of Dimes leads the effort to promote the well-being of all mothers and infants. We firmly believe that every newborn deserves the best possible beginning. However, not all infants have such an opportunity. We are determined to change this reality. Over the course of 80 years, March of Dimes has assisted countless infants in not only surviving but also thriving. Today, we are expanding upon this long-standing commitment to ensure fairness for all mothers and infants,

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NC BIRTHS RESEARCH REPORT DATA SET 6 irrespective of age, socioeconomic status, or demographic background. We provide unwavering support to expectant mothers throughout their pregnancy, especially in situations where things might not go as planned. We advocate for policies that prioritize the health of these mothers, while also seeking to enhance the quality of care they receive. Furthermore, we undertake innovative research aimed at finding remedies to the most significant health risks faced by both mothers and infants. Through our research, we focus on areas such as low birth weight, treatable health conditions, the importance of prenatal care, and the significance of choosing the right healthcare practitioner. We also strive to educate mothers on ways to mitigate the risk of low birth weight. Systematic Review of the Literature Summary and Relevance of the Literature to the problem or questions In 2004, a study was conducted on a random sample of 1,000 births in North Carolina to analyze the behaviors and practices of expecting mothers and their children. Among these births, 111 infants were found to have low birth weight. This paper aims to investigate the factors contributing to low birth weight, including the ages of the parents, the gestation period, whether the baby was born full-term or prematurely, the parents' marital status, the mother's weight gain, the baby's weight, the baby's gender, the mother's habits, and the mother's race. Thematic Findings in Literature as Applied to the Topic The Neonatal Intensive Care Unit (NICU) receives a distressing number of low birth weight babies who must stay there until they reach a healthy weight, with a significant number not surviving. For those who do survive, their journey to recovery and going home involves

NC BIRTHS RESEARCH REPORT DATA SET 7 gaining the necessary weight. This unfortunate situation deprives both the parent and baby of crucial bonding opportunities. However, there is hope as thorough research into the causes of low birth weight can prevent a substantial proportion of these cases. Key Definitions. Low Birth Weight (LBW) refers to the condition where a newborn weighs less than 5 pounds and 8 ounces at birth. Numerous regions globally suffer from a shortage of obstetrician- gynecologist (OB-GYN) experts. The Neonatal Intensive Care Unit (NICU) serves as a temporary residence for many infants until they reach a healthy birth weight to be discharged. Additionally, the data segment will analyze the subsequent terms:  Maturity – The mother's age during childbirth.  Habit - The maternal classification as a non-smoker or smoker. Ethical Consideration from the Literature Review. Start here Descriptive Statistics Type of Variables in the Data Set. Table 1: Variable list Variable Variable Type Low Birth Weight Numerical, Continuous, Ratio Scale Mother’s Maturity Status Categorical, Ordinal Scale Father’s Age Numerical, Discrete, Ratio Scale Length of Pregnancy Numerical, Discrete, Ratio Scale Doctor Visits Numerical, Discrete, Ratio Scale

NC BIRTHS RESEARCH REPORT DATA SET 8 Weight Gain Numerical, Continuous, Ratio Scale Martial Status Categorical, Nominal Scale Sex of Baby Categorical, Nominal Scale Habits Categorical, Nominal Scale White Mom Categorical, Nominal Scale This section will analyze the following questions:  What factors have caused low birth weight in this study?  Does the maturity rate affect low birth weight?  Does the father's age affect low birth weight?  Does the length of gestation cause a low birth rate?  The amount of doctor care or lack thereof affects the low birth rate?  Is the mother's weight gain a factor in the low birth rate?  Does marital status affect a low birth rate?  Is a particular baby's gender affect a low birth rate?  If the mother is a smoker, does that affect the birth rate?  Did the fact the mother was white or not affect the low birth rate? The following data highlights some of the variables examined in the 2004 North Carolina Study, including the percentage of low birth rates (111 out of 1000), maternal age, medical care received, duration of pregnancy among participants, and maternal weight gain during pregnancy. Table 2: Descriptive statistics Variable Mean Median Standard Deviation Low Weight Births 4.03 4.56 1.37 Mother’s Age 30.31 30 7.85

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NC BIRTHS RESEARCH REPORT DATA SET 9 Doctor’s Visit 10.8 10 4.82 Weeks in Gestation 33.43 34 4.68 Mother’s Weight Gained 26.08 25 14.34 Table 2 illustrates that the LBW standard deviation is 1.37, indicating the variability in low birth weight among the participants. Additionally, the median age of the mothers in the study is 30, suggesting that half of the mothers were younger than 30 and the other half were older. Furthermore, the mean number of doctor's visits during pregnancy is 10.8, which suggests that the average number of visits for the mothers in this study was 10.8. This emphasizes the importance of receiving prenatal care, as it is crucial in preventing low birth weight and birth complications. According to Tustison (2018, Para 8), babies born to mothers who do not receive prenatal care are three times more likely to have a low birth weight and experience complications during birth. Therefore, it is imperative and strongly recommended for expectant mothers to seek prenatal care to reduce the chances of these issues. The study also reveals that the mean gestational age is 33.43 weeks. Babies born between 33 and 34 weeks of gestation are considered premature and may require an extended stay in the Neonatal Intensive Care Unit (NICU). This is because their respiratory system is not fully developed until the final weeks of pregnancy, and their immune health is still compromised as antibodies begin to pass from the mother to the baby (Bird, 2020, Para 29 & 30).

NC BIRTHS RESEARCH REPORT DATA SET 10 Furthermore, the standard deviation for maternal weight gain is found to be 14.34. It is important to note that there is no defined "healthy" weight gain number during pregnancy. Each individual's needs may vary, and other factors must be taken into consideration. Although statistical data on how much weight a mother should gain during pregnancy is lacking, this section will analyze the available data and explain why the birth rate in North Carolina was 11% in 2004. Descriptive Graphs Figure 1. Total Births Low Birth Weight 1,000 111 Figure 1 illustrates the comparison between total births and instances of low birth weight. Despite the modest sample size, it was found that 11% of all births had a lower than average

NC BIRTHS RESEARCH REPORT DATA SET 11 birth weight. The study involved a randomly selected group of 1000 individuals who gave birth, and out of these, 111 babies were born with a low birth weight. Figure 2. Low Birth Weight Younger Mom Mature Mom 111 93 18 Based on Figure 2, there is a clear relationship between the age of the mother and the occurrence of low birth weight. The graph demonstrates that 83.8% of low weight babies were born to young mothers. Specifically, mothers aged 34 and younger accounted for the majority of low weight babies, with 93 out of 111 cases. In contrast, mature mothers aged 35 and over had only 18 out of 111 low weight babies. Evidently, these findings indicate a significant association between the age of the mother and the weight of the baby. Figure 3.

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NC BIRTHS RESEARCH REPORT DATA SET 12 Low Birth Weight Young Father Mature Father 111 93 18 Based on Figure 3, it can be observed that the age of the fathers corresponds with the information provided in Figure 2. The majority of low weight babies, specifically 93 out of 111, were born to younger fathers aged 34 and below. In contrast, mature fathers aged 35 and above only had 18 out of 111 low weight babies. The writer of this statement chose not to mention the exact ages of the fathers in Figure 3 in order to ensure an accurate comparison with the mothers. It is assumed that 30 of the mothers who took part in this study preferred not to disclose their age, unlike the fathers who did provide their age. Figure 4. Study’s Average Weeks in Gestation Weeks Considered Full Term 33 39

NC BIRTHS RESEARCH REPORT DATA SET 13 According to Figure 4, babies with a lower birth weight typically had a gestation period of 33 weeks. It should be noted that full-term babies are typically born between 39 weeks, 0 days and 40 weeks, 6 days (March of Dimes, 2020, Para 4). This graph clearly demonstrates a clear connection between the length of gestation and low birth weight. Figure 5. Study’s Average Visits Recommended Visits to Full Term 10 15

NC BIRTHS RESEARCH REPORT DATA SET 14 According to Figure 5, the average number of prenatal doctor's visits during pregnancy was significantly below the recommended number, with an average of only ten visits out of the recommended 15 visits, which accounts for about 66.6%. Research has shown that providing consistent and high-quality medical care to pregnant women from the early stages of pregnancy can help lower infant mortality rates and reduce the occurrence of low birth weight. This approach allows for the timely detection and resolution of potential issues before they negatively impact the developing fetus (Wymelenberg, 1990). Figure 6. Low Birth Weight Married Not Married 110 49 61

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NC BIRTHS RESEARCH REPORT DATA SET 15 The graph in Figure 6 illustrates that among the total of 111 babies with low birth weight, a greater number of them were born to unmarried parents compared to those born to married parents. Specifically, the graph shows that 61 out of 111 babies with low birth weight were born to unmarried parents, whereas 49 out of 111 were born to married parents. Therefore, the graph suggests that the likelihood of delivering a baby with low birth weight is higher for unwed mothers. Figure 7. Low Birth Weight Male Female 111 52 59

NC BIRTHS RESEARCH REPORT DATA SET 16 Figure 7 demonstrates a relatively similar occurrence of LBW in male and female infants, suggesting that gender might not be the determining factor behind low birth weight. Figure 8. Low Birth Weight Smoker Nonsmoker 111 18 92

NC BIRTHS RESEARCH REPORT DATA SET 17 The visual representation in Figure 8 illustrates the relationship between smoking and low birth weight. According to the data, nonsmokers have a higher occurrence of low birth weight babies. It can be observed from the figure that out of the 111 low weight babies, the mothers who smoked during pregnancy had a comparatively smaller number of low weight babies. It is worth noting that only 12.6% of the women who took part in this study reported themselves as smokers. The limited number of participants who admitted to smoking may introduce potential bias in the data. Figure 9. Low Birth Weight White Non White 111 68 59 According to Figure 9, out of the 111 low weight births, 61% were born to white mothers, specifically 68 in comparison to 59 born to non-white mothers.

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NC BIRTHS RESEARCH REPORT DATA SET 18 PROJECT ANALYSIS Analysis of the Literature Review Research Findings Simple Linear Regression Analysis [Insert which research question(s) you are answering] [Insert a table or paragraph of any regression statistics like the regression formula and r-squared value] [Insert simple linear regression scatterplot] [Insert your judgment based on the analysis performed] Single Sample Hypothesis Test of the Mean [Insert which research question(s) you are answering] [Insert a table or paragraph of any regression statistics like t statistic value, p-value, sample size, and level of significance] [Insert a picture of the analysis done in the spreadsheet] [Insert your judgment based on the analysis performed] Chi-Square Analysis [Insert which research question(s) you are answering] [Insert a table or paragraph of any chi-square statistics like the chi-square value, p-value, sample size, and level of significance] [Insert a picture of the contingency table in the spreadsheet] [Insert your judgment based on the analysis performed]

NC BIRTHS RESEARCH REPORT DATA SET 19 PROJECT SUMMARY Conclusions [Insert any conclusions you have drawn from the research] Specific Recommendations [Insert any recommendations you have drawn from the research] Suggestions for Future Research [Insert any suggestions for future research]

NC BIRTHS RESEARCH REPORT DATA SET 20 References Bird, C. "Premature Babies and Complications by Week ". Retrieved on December 5, 2023 from https://www.verywellfamily.com/premature-babies-week-by-week-2748606#:~:text=33– 34%20Weeks,a%20baby%20born%20at%20term CFI. (2015). "Ethical Dilemma". Retrieved on December 5, 2020 from https://corporatefinanceinstitute.com/resources/knowledge/other/ethical-dilemma/ Cutland CL, Lackritz EM, Mallett-Moore T, Bardaji A, Chandrasekaran R, Lahariya C, et al. (2017). "Low birth weight: Case definition & guidelines for data collection, analysis, and presentation of maternal immunization safety data". Retrieved on December 5, 2023 from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5710991/ Eiriksdottir, V. H., Asgeirsdottir, T. L., Bjarnadottir, R. I., Kaestner, R., Cnattingius, S., & Valdimarsdottir, U. A. (2013). "Low Birth Weight, Small for Gestational Age and Preterm Births before and after the Economic Collapse in Iceland: A Population Based Cohort Study". Retrieved on December 5, 2023, from https://journals.plos.org/plosone/article? id=10.1371/journal.pone.0080499 March of Dimes. (2020). " LOW BIRTHWEIGHT". Retrieved on December 5, 2023 from https://www.marchofdimes.org/complications/low-birthweight.aspx Marsa, L. (2018). "Labor pains: The OB-GYN shortage ". Retrieved on December 9, 2023 from https://www.aamc.org/news-insights/labor-pains-ob-gyn-shortage#:~:text=In%20fact %2C%20the%20American%20College,gynecologist%20(OB%2DGYN).&text=By %202020%2C%20there%20will%20be,to%2022%2C000%20by%20mid%2Dcentury

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NC BIRTHS RESEARCH REPORT DATA SET 21 World Health Organization. (2020). "Maternal, newborn, child and adolescent health". Retrieved on December 4, 2023 from https://www.who.int/teams/maternal-newborn-child-adolescent-health-and-ageing/covid- 19 Wymelenberg S. (1990). Science and Babies: Private Decisions, Public Dilemmas. Retrieved on December 4, 2023 from https://www.ncbi.nlm.nih.gov/books/NBK235274/

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