Preventing low birthweight

Low birthweight (LBW) is a major determinant of infant mortality in the US. Infants weighing 5.5 pounds or less are almost 40 times more likely to die during their 1st 4 weeks of life than the normal birthweight infant. Additionally, LBW survivors are at increased risk of health problems. To determine whether opportunities exist to reduce the incidence of LBW in the US, the Institute of Medicine convened an interdisciplinary committee in 1983 to study the causes and prevention of premature birth and intrauterine growth retardation, the twin contributors to LBW. The committee was asked to define those measures likely to be most effective in preventing LBW and to consider their costs in relation to the costs of caring for such infants. The committee concluded that the prevention of LBW could contribute significantly to a reduction in infant mortality in the US and, more generally, to improved child health. Policymakers and health professionals have enough information to intervene more vigorously to improve pregnacny outcome. Progress in the directions recommended by the committee will require recognition of the LBW problems as an important national issue. The committee recommends that leadership in the effort to reduce the occurrence of LBW be assumed in the executive branch of the federal government. Such leadership should include an increased commitment of resources to a range of activities likely to decrease LBW. This summary volume provides a brief overview of the issues covered in the full report and is directed to health care practitioners, legislators and their staffs, government administrators, and all others interested in the prevention of LBW. Areas covered are: the causes of LBW; planning for pregnancy; the impact of prenatal care; ensuring access to prenatal care; improving the content of prenatal care; and a public information program on LBW. Principal risk factors fall into 3 categories: demographic risks (age, race, low socioeconomic status, unmarrried status, low level of education); medical risks predating pregnancy (parity, low weight, genitourinary anomalies, certain diseases, e.g. diabetes, poor obstetric history, and maternal genetic factors); and medical risks in current pregnancy (including multiple pregnancy, poor weight gain, short interpregnancy interval, hypotension, certain infections, anemia, fetal anomalies and spontaneous premature labor).