{"doi":"10.17615/j17w-9h62","title":"Z -scores and the birthweight paradox","abstract":"Investigators have long puzzled over the observation that low-birthweight babies of smokers tend to fare better than low-birthweight babies of non-smokers. Similar observations have been made with regard to factors other than smoking status, including socio-economic status, race and parity. Use of standardised birthweights, or birthweight z-scores, has been proposed as an approach to resolve the crossing of the curves that is the hallmark of the so-called birthweight paradox. In this paper, we utilise directed acyclic graphs, analytical proofs and an extensive simulation study to consider the use of z-scores of birthweight and their effect on statistical analysis. We illustrate the causal questions implied by inclusion of birthweight in statistical models, and illustrate the utility of models that include birthweight or z-scores to address those questions.","journal":"ScholarWorks@UMassAmherst (University of Massachusetts Amherst)","year":2020,"id":117638,"datarank":0.0,"base_score":0.0,"endowment":0.0,"self_citation_contribution":0.0,"citation_network_contribution":0.0,"self_endowment_contribution":0.0,"citer_contribution":0.0,"corpus_percentile":null,"corpus_rank":null,"citation_count":1,"citer_count":0,"citers_with_citation_signal":0,"citers_with_endowment":0,"datacite_reuse_total":0,"is_dataset":false,"is_dataset_confidence":0.9531,"is_data_producer":false,"deposit_databanks":null,"is_oa":true,"file_count":0,"downloads":0,"has_version_chain":false,"published_date":"2020-01-01","fair_score":null,"fair_percentile":null,"algorithm_id":"datarank_citation_only_1hop_v6","ranking_scope":"data_only","authors":[{"id":311701,"name":"Sunni L. Mumford","orcid":"0000-0003-0133-3176","position":1,"is_corresponding":false},{"id":311707,"name":"Enrique F. Schisterman","orcid":"0000-0003-3757-641X","position":2,"is_corresponding":false},{"id":320647,"name":"Brian W. Whitcomb","orcid":"0000-0002-8646-5823","position":3,"is_corresponding":false},{"id":17400,"name":"Robert W. Platt","orcid":"0000-0002-5981-8443","position":0,"is_corresponding":true}],"reference_count":0,"raw_metadata":null,"created_at":"2026-07-18T23:13:54.951170Z","pmid":null,"pmcid":null,"fwci":null,"citation_percentile":null,"influential_citations":0,"oa_status":null,"license":null,"views":0,"total_file_size_bytes":0,"version_count":0,"fair_f":null,"fair_a":null,"fair_i":null,"fair_r":null,"fair_zscore":null,"fair_rationale":null,"fair_model":null,"fair_agent_version":null,"fair_fulltext_source":null,"fair_has_llm":null,"fair_computed_at":null,"clinical_trials":[],"software_tools":[],"db_accessions":[],"linked_datasets":[],"topics":[]}