Studies have rarely considered the impact of paternal factors on perinatal outcomes generally or on racial differences therein. Shah et al have produced a literature review that begins to delve into the contribution of fathers to the risk of adverse birth outcomes. Paternal exposures that were selected for inclusion in their database search were father’s age, anthropometry (eg, height, weight), self birthweight, occupational exposures, and education. After a systematic search of the literature, the authors identified the father’s age, current weight, and his own birthweight as risk factors for low birthweight and suggest that paternal occupation and education may be important but have not consistently been reported to increase the risk of adverse birth outcomes.
See related article, page 103
Although the authors are to be commended for bringing attention to the role of fathers, the literature review represents a rather narrow examination of the potential contributions of fathers to birth outcomes. Paternal factors may influence birth outcomes through a number of pathways that include factors that act indirectly through maternal factors on birth outcomes. Indirect paternal influences may be as important to understand as those paternal factors that act directly on birth outcomes. Although Shah et al take an important first step by highlighting the most frequently examined paternal risk factors that are associated directly with adverse birth outcomes, the potential indirect effects are not fully realized.
As shown in the Figure , multiple domains are pertinent to an examination of paternal factors in birth outcomes, which include their intersection with maternal factors that represent potential mediating and moderating pathways. However, the Shah et al review gives little attention to paternal factors in the psychosocial domain that reflects this research. This includes fathers’ attitudes regarding the pregnancy, fathers’ behaviors during the prenatal period, and the relationship between fathers and mothers. Evidence is emerging that such factors may indirectly influence risk for adverse birth outcomes, with implications for potentially explaining racial disparities in this area. One such indirect paternal psychosocial pathway may operate through maternal stress because higher levels of maternal stress have been associated with increased risk of preterm births. Another pathway could be through the effect of fathers on maternal health behaviors that include the use of prenatal care, maternal smoking and drug use during pregnancy, and maternal health behaviors that have been linked to adverse birth outcomes. For example, findings from the Pregnancy Risk Assessment Monitoring System 2000-2003 data show that early prenatal care was less likely when fathers were reportedly ambivalent or did not want the pregnancy. Further, the Fragile Families study found that prenatal financial and in-kind financial contributions by fathers were associated with higher rates of prenatal care and lower rates of maternal alcohol use. Early prenatal care rates also were highest for married mothers, followed by those cohabiting, with rates lowest for mothers in romantic but noncohabiting relationships; similarly, mothers’ smoking and drug use were significantly lower for married women. Furthermore, risk of low birthweight was highest among mothers in romantic noncohabiting relationships, compared with mothers who were married, cohabiting, or those uninvolved with the father. Paternal factors could also amplify or diminish effects of maternal factors. In a study that examined joint effects, fathers’ smoking amplified the effect of mothers’ smoking on birthweight.
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