Can Low Birth Weight be Prevented?

In the US low birth weight is the major factor associated with the death of infants in the 1st 4 weeks of life. Over the 1st 1/2 of the century, infant mortality declined from about 100 to about 30 deaths/1000 live births. But most of this decline has been attributed to decreases in the rate of postneonatal mortality (deaths from 28 days to the 1st birthday). Declines in low-birth-weight rates have been concentrated among babies whose mothers are at lowest risk. Low-birth-weight infants who do survive face increased risk of a range of childhood illnesses and developmental problems. The problem of low birth weight is also important for economic reasons. More than US$1.5 billion is spent annually on neonatal intensive care services in the US. Teenage mothers, blacks, and women of low socioeconomic status are at high risk of having a baby of low birth weight. Pregnancy intervals of shorter than 6 months, a variety of chronic illnesses, multiple pregnancies, smoking, and failure to obtain, or delay in initiating, prenatal care also increase the risk that a woman will have a low-birth-weight baby. The Institute of Medicine committee has outlined an approach to the prevention of low birth weight that emphasizes 5 principal points: 1) pre-pregnancy identification of high risk women with more and improved counseling, health education, and family planning services; 2) increase the availability and quality of early prenatal care; 3) strengthen and expand the content of prenatal services; 4) mount a public information campaign aimed at preventing low-birth-weight; 5) research. If these measures are implemented, it has been estimated that US$41 million can be saved each year from the US$188 million the government spends annually for the care of low-birth-weight babies. The federal government must take a leadership role if these measures are to be successful.