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Preventing Low Birthweight (1985) / Chapter Skim
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Summary and Recommendations
Pages 1-18

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From page 1...
... Although low birthweight is not a major determinant of the total burden of morbidity among infants and children, the relative risk of morbidity among low birthweight infants is high. The association of neurodevelopmental handicaps and congenital anomalies with low birthweight has been well establi shed; low birthweight infants also may be susceptible to a wide range of other conditions, such as lower respiratory tract infections r learning disorders, behavior problems, and complications of neonatal intensive care interventions.
From page 2...
... , ch~ldbear ing at extremes of the reproductive age span, and being unmarried; medical risks that can be identified before pregnancy, such as a poor obstetric history, certain diseases and conditions, and poor nutritional status; problems that are detected dur ring pregnancy, such as poor weight gain, bacter fur ia, toxemia/preeclamps~a, short interpregnancy interval, and multiple pregnancy; behavioral and environmental r isks, such as smoking, alcohol and other substance abuse, and exposure to various toxic substances; and the health care r isks of absent or inadequate prenatal care and iatrogenic prematur ity. Newer hypotheses suggest that another group of factors also may place a woman at risk of low birthweight, particularly preterm labor: stress, uterine irritability, certain cervical changes detected before the onset of labor, some infections, inadequate plasma volume expansion, and progesterone def ic iency.
From page 3...
... The r isks of low birthweight among teenagers probably derive more from other factors associated with teenage childbear ing {such as low socioeconomic status and poor utilization of prenatal care} than from young age itself.
From page 4...
... The committee performed a multivar late tabulation of single live births in the United States dur ding 1981 according to educational attainment, mar ital status, age/birth order category, and the timing and quantity of prenatal care. With all other factors controlled, a change in timing of initiation of prenatal care was associated with a minor reduction in the r isk of low birthweight.
From page 5...
... The committee was not able to calculate the cost or costeffectiveness of most of the recommended interventions because of problems in the qual ity and uniformity of available cost data, difficulties In delineating the services received, and uncertainties about target populations. The committee found, however , that it could perform a straightforward analysis of some of the f inancial implications involved ~ n the provision of prenatal services to pregnant women.
From page 6...
... Health care professionals should pay special attention to r isk factor identif ication and reduction in these women. Realizing the benefits of prepregnancy risk identification will require: · further discussion by the relevant professional groups of the content and timing of counseling, with particular attention to data on the risks associated with low birthweight (and other poor pregnancy outcomes)
From page 7...
... The Title X program and family planning services should be regarded as important parts of the public effort to prevent low bir thwe ight . Ensuring Access to Prenatal Care Efforts to reduce the nation's incidence of low b~rthweight must include a commitment to enrolling all pregnant women in prenatal care.
From page 8...
... This finding is strong enough to support a broad national commitment to ensuring that all pregnant women, especially those at socioeconomic or medical risk, receive high-qual~ty prenatal care. National, state, and local data indicate that the proportion of mothers beginning prenatal care in the first trimester increased steadily from 1969 until 1980, but that this trend has leveled off or possibly reversed since 1981.
From page 9...
... 3. The possibility that there are insufficient prenatal care services in sites routinely used by high-risk populations, such as Community Health Centers, Maternity and Infant Care Projects' hospital outpatient departments, and health departments: The committee emphasizes the importance of these organized facilities, especially local health departments, in the effort to increase access to prenatal care.
From page 10...
... More research is needed, however, on the comparative advantages of different case-finding approaches, the costs of different outreach systems and their effectiveness, and the types of personnel best suited to various program goals and target groups. A System of Accountability The committee believes that although many different factors contribute to the problem of inadequate access to prenatal care, an underlying cause is the nation's patchwork, nonsystematic approach to making prenatal services ava, lable.
From page 11...
... The federal government, which has long supported prenatal care and urged that all women secure such care early in pregnancy, is uniquely positioned to play a leadership role in the effort to ensure access to prenatal services. The committee recommends that the federal government, through the Department of Health and Human Services, increase its commitment to these goals by: · providing sufficient funds to state and local agencies to remove financial barriers to prenatal care (through channels such as the Maternal and Child Health Services Block Grants, Medicaid, health departments, Community Health Centers, and related systems)
From page 12...
... For example, current prenatal care seems particularly oriented toward the prevention, detection, and treatment of problems that are manifested in the third trimester. By contrast, may of the risks associated with low birthweight, including smoking and poor nutritional status, require attention early in pregnancy.
From page 13...
... 5. Increasing the detection and management of behavioral risks: Prenatal care should include explicit attention to detecting behavioral risks associated with low birthweight, especially smoking, nutritional inadequacies, moderate to heavy alcohol use, and substance abuse.
From page 14...
... Programs Complementary to Prenatal Care Because many of the risks associated with low birthweight have a behavioral basis, the committee examined selected interventions designed to reduce these risks, including smoking reduction strategies and nutritional intervention programs such as the Special Supplemental Food Program for Women, Infants and Children (WIC) The committee urges that efforts to help women stop or reduce smoking in pregnancy become a major concern of obstetric care providers.
From page 15...
... assessment of the efficacy and safety of numerous individual components of prenatal care; and (3) evaluation of certain well-defined combinations of prenatal care interventions designed to meet the widely varied needs and risks among pregnant women.
From page 16...
... Also, the statistical profile of the nation's health developed by the National Center for Health Statistics, Bealth: United States, periodically should include a special supplement or profile on low birthweight and its prevention. Because many of the risk factors for low birthweight are widely d ~ str ibuted throughout the population, and because a substantial amount of low birthweight occurs among women judged to be at low risk, the committee concluded that a public information program on low birthweight should embrace a broad audience.
From page 17...
... The analysis showed that if the expanded use of prenatal care reduced the low birthweight rate in the target group from 11.5 percent to only 10.76 percent, the increased expenditures for prenatal services would be approximately equal to a single year of cost savings in direct medical care expenditures for the low birthweight infants born to the target population. If the rate were reduced to 9 percent (the 1990 goal set by the Surgeon General for a maximum low birthweight rate among high-risk groups)


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