OBJECTIVE: To test the hypothesis that the erosion of family structure, epidemic substance abuse, and increased low birth weight (LBW) rates are interrelated. METHODS: In this cohort study, we analyzed information coded prospectively in a computerized perinatal data base. Separated, divorced, and widowed mothers were grouped as broken marriages. The setting was a predominantly urban, indigent population in a tertiary care hospital. The analysis included singleton pregnancies of 14,896 women receiving prenatal and intrapartum care at our hospital from 1986-1991. The main outcome measures included LBW, prematurity, small for gestational age, neonatal mortality, and neonatal intensive care unit admissions. RESULTS: Married mothers fared better than single mothers, but risks for adverse perinatal outcomes for women with broken marriages were consistently as high or higher than for single mothers. The rate of LBW infants was 43 higher in the broken marriage group than in the married group. The increased frequency of LBW among infants born into broken marriages was attributable mainly to reduced growth rather than to prematurity and was associated with substance abuse. CONCLUSION: Our findings indicate that mothers from broken marriages are at relatively higher risk for LBW infants than married mothers (odds ratio 1.5). Broken marriage warrants emphasis as an important perinatal risk factor.
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