This study examines whether an epidemiological paradox exists for low birth weight, preterm birth, small for gestational age, and large for gestational age among Hispanic mothers in Colorado. It compares birth outcomes by race/ethnicity and place of birth (Mexico or U.S.) to identify individual- and neighborhood-level contributors and to contextualize quantitative findings.

The study analyses two retrospective cohorts all mothers (N=356,389) and mothers of Mexican origin (N=85,755) delivering singletons in Colorado during 2000–2005, using multiple logistic regression to test the social gradient of health by race/ethnicity and by nativity, to identify any paradoxical outcomes, and to explore the healthy migrant and healthy immigrant explanations for better outcomes among Mexican-born mothers. General linear regression analyzes the association of neighborhood deprivation and immigrant orientation for mothers of Mexican origin in Adams (N=16,107) and Denver (N=23,332) Counties. Five interviews with key informants and ten interviews with mothers of Mexican origin, half of whom were born in Mexico, are analyzed using directed content analysis.

Four key findings emerge. First, an epidemiological paradox exists for Hispanics for all four birth outcomes, despite having worse social and medical profiles than non-Hispanic White mothers. Second, the paradox exists for Mexican-born mothers for low birth weight, preterm birth, and small for gestational age. No paradox exists for large for gestational age. Third, neither the healthy migrant nor healthy immigrant explanation is supported. Finally, neighborhood measures of immigrant orientation and neighborhood deprivation do not influence the likelihood of outcomes in Adams and Denver Counties.

The public health importance centers on the identification of a hidden epidemic of large for gestational age among Mexican-born mothers and insight into the structure of health disparities. Any paradox at the low-weight end of the spectrum of birth outcomes no longer obscures the existence of negative high-weight outcomes, an important finding in Colorado where Hispanics represent 30% of singleton births. The broader political economic perspective suggests that reliance on individual-level interventions alone is insufficient to reduce LGA disparities because Mexican-born immigrants are constrained by structural barriers to better health outcomes, including poverty, lack of access to healthy foods, and social and linguistic isolation.