Despite recent declines in infant mortality, the rates of low birthweight deliveries in the United States continue to be high. Part I of this volume defines the significance of the problems, presents current data on risk factors and etiology, and reviews recent state and national trends in the incidence of low birthweight among various groups. Part II describes the preventive approaches found most desirable and considers their costs. Research needs are discussed throughout the volume.

Contents

• Committee to Study the Prevention of Low Birthweight
• PREFACE
• ACKNOWLEDGMENTS
• SUMMARY AND RECOMMENDATIONS
  • ETIOLOGY AND RISK FACTORS
  • TRENDS IN LOW BIRTHWEIGHT
  • AN OVERVIEW OF PREVENTIVE APPROACHES
  • PLANNING FOR PREGNANCY
  • ENSURING ACCESS TO PRENATAL CARE
  • IMPROVING THE CONTENT OF PRENATAL CARE
  • A PUBLIC INFORMATION PROGRAM
  • COST ISSUES
• I. DEFINITIONS, RISK FACTORS, AND TREND
  • 1. The Significance of Low Birthweight
    • CURRENT CONCEPTS OF FETAL GROWTH
    • BIRTHWEIGHT AND INFANT MORTALITY
    • LOW BIRTHWEIGHT AND MORBIDITY
    • SUMMARY
    • REFERENCES AND NOTES
  • 2. Etiology and Risk Factors
    • ETIOLOGY
    • RISK FACTORS: AN OVERVIEW
    • DEMOGRAPHIC RISKS
    • MEDICAL AND OBSTETRIC RISKS
    • NUTRITION
    • BEHAVIORAL AND ENVIRONMENTAL RISKS
    • IATROGENIC RISKS
    • EVOLVING CONCEPTS OF RISK
    • RISK ASSESSMENT
    • CONCLUSIONS
    • References
  • 3. Trends in Low Birthweight
    • OVERALL TRENDS IN LOW BIRTHWEIGHT RATES
    • THE COMPOSITION OF LOW-WEIGHT BIRTHS
    • SOCIODEMOGRAPHIC CHARACTERISTICS
    • PREGNANCY HISTORY
    • PRENATAL CARE
    • ANALYSIS OF 1981 SINGLE LIVE BIRTHS IN THE UNITED STATES
    • CONCLUSIONS
    • References and Notes
• II. REDUCING THE INCIDENCE OF LOW BIRTHWEIGHT
  • 4. An Overview of Promising Interventions
    • PROMISING STRATEGIES
    • NATIONAL DIRECTION FOR AN NATIONAL PROBLEM
    • References and Notes
  • 5. Planning for Pregnancy
    • PREPREGNANCY RISK IDENTIFICATION AND REDUCTION
    • ENLARGING THE CONTENT OF HEALTH EDUCATION
    • THE ROLE OF FAMILY PLANNING IN REDUCING LOW BIRTHWEIGHT
    • SUMMARY
    • References and Notes
  • 6. The Effectiveness of Prenatal Care
    • ISSUES IN STUDYING THE EFFECTS OF PRENATAL CARE
    • REVIEW OF STUDIES OF PRENATAL CARE EFFECTS
    • CONCLUSIONS
    • References and Notes
  • 7. Ensuring Access to Prenatal Care
    • WHO RECEIVES INADEQUATE PRENATAL CARE
    • WHY DO SOME WOMEN OBTAIN INADEQUATE PRENATAL CARE
    • FINANCIAL CONSTRAINTS
    • MATERNITY CARE PROVIDERS
    • INSUFFICIENT PRENATAL CARE SERVICES
    • WOMEN'S EXPERIENCES, ATTITUDES, AND BELIEFS
    • TRANSPORTATION AND CHILD CARE
    • INCREASING THE CAPACITY FOR OUTREACH
    • A SYSTEM OF ACCOUNTABILITY AND RESPONSIBILITY
    • References and Notes
  • 8. Improving the Content of Prenatal Care
    • CARE FOR ALL PREGNANT WOMEN
    • PROGRAMS COMPLEMENTARY TO PRENATAL CARE
    • ENCOURAGING CHANGE IN PRENATAL SERVICES
    • RESEARCH NEEDS
    • SUMMARY
    • References and Notes
  • 9. A Public Information Program
    • CONDITIONS FOR SUCCESS
    • A PUBLIC INFORMATION PROGRAM ON LOW BIRTHWEIGHT PREVENTION
    • References
  • 10. Prenatal Care and Low Birthweight: Effects on Health Care Expenditures
    • OVERVIEW OF THE ANALYSIS
    • DESCRIPTION OF COSTS
    • RESULTS OF THE COST COMPARISON
    • SUMMARY
    • References and Notes
• APPENDIXES
  • Appendix A Risk Factors Associated with Low Birthweight
  • Appendix B Data On Selected Low Birthweight Trends
  • Appendix C A Summary of Three Prematurity Prevention Programs
  • Appendix D Notes On National Data Available To Study Low Birthweight Trends and To Monitor Related Programs

NOTICE: The project that is the subject of this report was approved by the Governing Board of the National Research Council, whose members are drawn from the councils of the National Academy of Sciences, the National Academy of Engineering, and the Institute of Medicine. The members of the committee responsible for the report were chosen for their special competences and with regard for appropriate balance.