Determinants of low birth weight: methodological assessment and meta-analysis.

43 determinants of low birth weight were analyzed from 895 published papers in the English and French literature from 1970-1984. The assessment was limited to singleton births of women living at sea level with no chronic illness; rare factors and complications of pregnancy were excluded. The 43 factors were categorized as genetic and constitutional, demographic and psychosocial, obstetric, nutritional, maternal morbidity during pregnancy, toxic exposure and antenatal care. The existence and magnitude of a causal effect on birth weight, gestational age, prematurity and intrauterine growth retardation were determined by a set of methodological standards. In developed countries, the most important factor was cigarette smoking, followed by nutrition and pre-pregnancy weight. In developing countries the major determinants were racial origin, nutrition, low pre-pregnancy weight, short maternal stature, and malaria. Pre-pregnancy weight, prior premature birth or miscarriage, diethylstilbestrol exposure and smoking were major determinants of gestational duration, but the majority of prematurity was unexplained in both developed and developing countries. There is a need for future research on the effect of maternal work, prenatal care, and certain vitamin and mineral deficiencies on intrauterine growth, and the effect of genital tract infection, prenatal care, maternal employment, stress and anxiety on prematurity.