Relationship between Structural and Intermediate Social Determinants of Health and Low Birth Weight: A Path Analysis

Document Type: Original Article


1 Social Determinants of Health Research Center, Alborz University of Medical Sciences, Karaj, Iran

2 Department of Midwifery, School of Nursing and Midwifery, Ilam University of Medical Sciences, Ilam, Iran

3 Department of Midwifery and Reproductive Health, School of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran


Background: Low birth weight is one of the most important health indicators for assessing the status of newborns in every country. It is, therefore, necessary to identify factors associated with this adverse pregnancy outcome. This study was conducted to determine predicting factors associated with low birth weight using path analysis.
Methods: This prospective study was performed on 719 eligible pregnant women with a gestational age of 24-28 weeks who visited the health centers in Ilam, Iran. The participants were selected through stratified cluster sampling. The data were collected using relevant scales and analyzed using SPSS software (version 19.0) and LISREL (version 8.8).
Results: The incidence rate of low birth weight was obtained at 7.5%. The risk scores of low birth weight were 2.7, 2.5, 3.3, 1.8, and 2.8 times higher in the participants with stress, anxiety, depression, domestic violence, and food insecurity, respectively, compared to those without the mentioned conditions. The goodness of fit index confirmed the favorable fit of the model. The most influential direct determinants of birth weight were the number of prenatal visits (β=0.19) and mother’s body mass index (β=0.02). The most important direct determinant of birth weight was stress in this study (β=-58.006).
Conclusion: The etiology of low birth weight is complex and may involve demographic characteristics, as well as nutrition, reproductive, and socioeconomic factors. Given that prenatal care and psychological and nutritional factors are the major determinants, it is essential to take fundamental steps, including the improvement of living standards and nutritional status in pregnant women, more regular prenatal care visits, and pre-conception counseling.