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Preventing Low Birthweight (1985) / Chapter Skim
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3. Trends in Low Birthweight
Pages 94-112

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From page 94...
... This chapter attempts to understand the recent past in seeking means to reduce future low birthweight rates. Three categories of questions are examined.
From page 95...
... Nevertheless, the committee believes that important insights about trends In low birthweight rates and changes in the composition of the low birthweight population can be gained from information available on the birth record. Overall Trends in Low B~rthweight Rates Table 3.1 shows changes in low birthweight rates in the United States and the five selected states from 1971 to 1981.
From page 96...
... J Table 3.2 and Tables B.3 and B.4 show trends in live births and late fetal deaths . I f changes in medical pract' ce or bir th cer tif ication have moored increasing numbers of pregnancies from the fetal death category to the live birth category, then the computed trend in low birthweight rates among live births may understate the actual rate of decline in low-weight rates among all pregnancies.
From page 97...
... Table 3.4 shows more detailed trends in low birthweight rates In relation to gestational age for the selected states. Interpretation of the results needs to be tempered by the uncertain quality of data on duration of pregnancy.
From page 98...
... For the United States as a whole, the relative decline in white low birthweight rates exceeded the corresponding relative decline in black low birthweight rates. Thus, white low birthweight rates declined by
From page 99...
... For the remaining states studied, however, the trends accord with that observed nationally. It is noteworthy that both white and black low birthweight rates vary across states.
From page 100...
... The relationship between education and low birthweight rates prevails among individual maternal age groups (Appendix Table B.91. There is no indication of a narrowing gap In relative r isk among births to mothers with disparate educational attainment.
From page 101...
... For two selected states, Table 3.9 presents trends in low birthweight rates in relation to a simple two-way classification of soc~odemographic risk factors. ~High-risk.
From page 102...
... declines in low birthweight rates have been concentrated in ache lower isk groups . Such evidence supper ts the conclus ion that the gap in low birthweight rates between low-risk and high-risk groups, at least as defined by maternal sociodemographic characteristics, is not closing.
From page 103...
... Still, the narrowing of the gap observed is one of the few evidences of positive change in relative risk during the 1971-1981 period. Special tabulations on 1981 live births, performed by the National Center for Health Statistics for this report, showed the relationship of birthweight to interval between termination of ~h`?
From page 104...
... 1. TABLE 3.10 Relative Risk of Low Birthweight by Birth Order, Outcome of Prior Pregnancy, and Race: United States, 1971, 1976, and 1981 Relative Riska Percent Distribution White Black Total Live Births tl981)
From page 105...
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From page 106...
... short interval between pregnancies and of declining relative risk with increases in the interpregnancy interval is found at every age and birth order. An independent effect of interpregnancy interval on birthweight remains apparent even after controlling for the potentially confounding variables of age, birth order, race, marital status, and educational attainment.
From page 107...
... Analysis of trends in low birthweight rates in relation to prenatal care is complicated by variations over time in the number of states reporting data on such care. From reporting states (see Appendix Table B.12)
From page 108...
... The upper part of Table 3.13 shows, for whites and blacks separately, the estimated effect on the 1981 low birthwe~ght rate of eliminating all late prenatal care and the associated excess risk, as well as the estimated effect of eliminating late prenatal care and improving selected maternal risk factors (less than 12 years education, unmarried status, and high age of mather/b~rth order (ABO) risk, as defined in Table 3.13~.
From page 109...
... Reductiona (per 1,000) Reductions Original base rate 47 -- 112 Estimated rate after elimination of excess risk among births with:b Late prenatal care 46 3 107 __ 3 Late prenatal care and less than high school education, unmarried status, or high ABO risks 38 20 84 24 Estimated rate after elimination of excess risk among births with:b Nonadequate prenatal care 40 15 97 12 Nonadequate prenatal care and less than high school education, unmarried status, or high ABO risks 34 29 77 30 NOTE: United States, excluding births in California, New Mexico, Texas, and Washington, which did not report mother's education or number of prenatal visits.
From page 110...
... For the United States, the proportion of low-weight births declined from 7.6 percent of live births in 1971 to 6.8 percent of live births in 1981. Although Massachusetts showed a more marked decline in low birthweight rates than the other states, the relative declines in all of the states and the United states were of the same order of magnitude (Table 3.
From page 111...
... The committee performed a multivariate tabulation of single live births in the United States during 1981 according to educational attainment, marital status, age/b~rth order category, and the timing and quantity of prenatal care. With other factors controlled, a change in only timing of prenatal care starts was associated with a minor reduction in risk of low birthweight.
From page 112...
... vital record data alone may not gauge adequately the content and effectiveness of prenatal care; nor do such data character ize important aspects of maternal behavior (such as cigarette smoking) and medical history {such as maternal diabetes)


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