for gestational age are also at increased risk to repeat, especially if fetal growth was restricted because of a persistent condition such as maternal hypertensive disease. Thus, a history of LBW identifies a cohort of women at increased risk of delivering another LBW infant.

There is some basis for anticipating benefit from nutritional intervention in case of preterm birth and fetal growth restriction. Since a history of LBW identifies women at increased risk for either of these two conditions, the committee recommends use of a history of LBW as a nutrition risk criterion.

History of Neonatal Loss

Neonatal loss is a vague term that encompasses death of the neonate from any cause. As such, it is not a useful nutritional risk criterion for the WIC program. History of LBW already encompasses a major contributing factor to neonatal death.

History of Previous Birth of an Infant with a Congenital or Birth Defect

Prevalence of and Factors Associated with a History of Previous Birth of an Infant with a Congenital or Birth Defect

See the section "Genetic and Congenital Disorders" for information.

History of Previous Birth of an Infant with a Congenital or Birth Defect as an Indicator of Nutrition and Health Risk

Women who have previously had an infant affected by a neural tube defect are at increased risk of a recurrence (MRC Vitamin Study Research Group, 1991). Recent studies suggest that intake of folic acid may also be inversely related to the occurrence of cleft lip or cleft palate (Shaw et al., 1995).

History of Previous Birth of an Infant with a Congenital or Birth Defect as an Indicator of Nutrition and Health Benefit

For improved nutrition to reduce risk of recurrence of birth defects, the woman's increased nutrient intake needs to occur prior to and in the early weeks of pregnancy. Except in the case of closely spaced pregnancies, this is not ordinarily a period when women are served by the WIC program. It is not known if improved nutrient intake will lead to other improvements in pregnancy outcome.



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