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What seems to make more difference to birth weight in the developed countries is maternal stress in pregnancy. A study of 2,378 women in Missouri found that mothers of LBW babies are more likely to give histories of stressful pregnancies (Sable and Wilkinson 2000).There is also evidence that if you stress animals in pregnancy, they have smaller offspring (Drago, Di Leo, and Giardina 1999). Some of the mechanisms ... are now understood. For instance, anxious mothers seem to have reduced uterine blood flow (Texeira, Fisk, and Gloves 1998).
Mothers stressed in pregnancy have higher cortisol levels and there is a strong correlation between maternal and fetal cortisol, which shows that babies are affected by maternal stress before birth (Gitau et al 1998).
From Richard Wilkinson, The Impact of Inequality, 2005.
Drug abuse (alcohol and tobacco included) may be causal factors in low birth weight, but they themselves are symptoms:
Many women who use drugs have faced serious challenges to their well-being during their lives. For example, research indicates that up to 70 percent of drug abusing women report histories of physical and sexual abuse. Data also indicate that women are far more likely than men to report a parental history of alcohol and drug abuse. Often, women who use drugs have low self-esteem and little self-confidence and may feel powerless. In addition, minority women may face additional cultural and language barriers that can affect or hinder their treatment and recovery.
From a National Institute on Drug Abuse Factsheet
It would seem fairer to look at the overall situation of young women in multi-generational poverty, at the psychological price of poverty, than to pinpoint drug abuse as the core of the problem. (Though a problem of course it is.)
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