Click for next page ( R2


The National Academies | 500 Fifth St. N.W. | Washington, D.C. 20001
Copyright © National Academy of Sciences. All rights reserved.
Terms of Use and Privacy Statement



Below are the first 10 and last 10 pages of uncorrected machine-read text (when available) of this chapter, followed by the top 30 algorithmically extracted key phrases from the chapter as a whole.
Intended to provide our own search engines and external engines with highly rich, chapter-representative searchable text on the opening pages of each chapter. Because it is UNCORRECTED material, please consider the following text as a useful but insufficient proxy for the authoritative book pages.

Do not use for reproduction, copying, pasting, or reading; exclusively for search engines.

OCR for page R1
Preventing Low Birthweight Committee to Study the Prevention of Low Birthweight Division of Health Promotion and Disease Prevention INSTITUTE OF MEDICINE NATIONAL ACADEMY PRESS Washington, D.C. 1985

OCR for page R1
NATIONAL ACADEMY PRESS 2101 Constitution Avenue, NW Washington, DC 20418 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 En~eenng, and the Institute of Mediane. The members of the committee responsible for the report were chosen for their special competences and with regard for appropriate balance. This report has been reviewed by a group other than the authors according to the procedures approved by a Report Review Committee consisting of members of the Nation- al Academy of Sciences, the National Academy of Engineenng, and the Institute of Mediane. The Institute of Medicine was chartered in 1970 by the National Academy of Sciences to enlist distinguished members of the appropriate professions in the examination of policy matters pertaining to the health of the public. In this, the Institute acts under both the Academy 1863 congressional charter responsibility to be an adviser to the federal govem- ment and its own initiative in identifying issues of medical care, research, and education. A digest of this volume is availablefrom the National Academy Press at the address above Please inquire for once and quantity discounts. Library of Congress Catalog Card Number 84~2849 International Standard Book Number 0-309-03530-9 Cover photo by Susie F~tzhugh for Children's Hospital National Medical Center, Washington, D.C. Printed in the United States of America

OCR for page R1
Committee to Study the Prevention of Low Birthweight RICHARD E. BEHRMAN, Chairman, Committee to Study the Prevention of Low Bir~weight, Instih~te of Medicine, and Dean, School of Medicine, Case Western Reserve University, Cleveland, Ohio JEFFREY E. IS, Associate Professor, Depa~ent of Economics, Massachusetts Institute of Technology, Cambridge, Massachusetts, and Clinical Associate, Massachusetts General Hospital, Boston, Massachusetts CALM ]. HOBEL, Professor of Obstetrics, G~ecolo~ and Peas, School of Medicine, University of California at Los Angeles, and Director, Matemal-Fetal Medicine, Cedars Sinai Medical Center, Los Angeles, California JEROME O. KLEIN, Professor of Pediatrics, Boston University School of Medicine, and Director, Division of Pediatric Infectious Diseases, Boston City Hospital, Boston, Massachusetts LUELLA KLEW, President, American College of Obste~aans and Gynecologists, and Professor of Gynecology and Obstetrics, Emory University School of Medicine, Atlanta, Georgia MARIE C. MCCORMICK, Assistant Professor of Pecliatrics, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania JAMES METCALFE, Professor of Medicine, Oregon Health Sciences University, Portland, Oregon C. ARDEN MILLER, Professor and Chairman, Depa' lenient of Maternal and Child Health, School of Public Health, University of North Carolina at Chapel Hip, Chapel Hip, North Carolina JO~ T. QUEENS, Professor and Chapman, Department of Obstetrics and Gynecology, Georgetown University Hospital, Washington, D.C. JIJ[IUS B. RICHMOND, Director, Division of Health Policy Research and Education, and John D. MacArthur Professor of Health Policy and Management, Harvard University, Boston, Massachusetts I~ P. ROOM, President, American College of Nurse-~ves, Portlancl, Oregon SAM SHAP~Ro, Professor of Health Policy and Management, and Past Director, Health Services Research and Development Center, School of Hygiene and Public Health, Johns Hopkins University, Baltimore, Maryland . . . 111

OCR for page R1
Study Staff SARAH S. BROWN, Study Director, Committee to Study the Prevention of Low Birthweight ENRIQUETA C. BOND, Director, Division of Health Promotion and Disease Prevention STEPHANIE C. BRUGLER, Research Assistant, Division of Health Promotion and Disease Prevention EVE K. NICHOLS, Editor, Division of Health Promotion ant! Disease Prevention WALLACE K. WATERFALL, Editor, Institute of Medicine LINDA DEPUGH, Administrative Secretary, Division of Health Promotion and Disease Prevention NAOMI HUDSON, Administrative Secretary, Division of Health Sciences Policy Consultant LORRAINE KLERMAN, Professor of Public Health and Head, Division of Health Services Administration, Department of Epidemiology and Public Health, School of Medicine, Yale University, New Haven, Connecticut Commissioned Papers ROBERT GOLDENBERG, Professor of Obstetrics and Gynecology, Department of Obstetrics and Gynecology, The University of Alabama, Birmingham, Alabama VILMA HUNT, Professor of Public Health, Pennsylvania State University, University Park, Pennsylvania LORRAINE KLERMAN, Professor of Public Health and Head, Division of Health Services Administration, Department of Epidemiology and Public Health, School of Medicine, Yale University, New Haven, Connecticut CAROL C. KORENBROT, Research Specialist, Center for Population and Reproductive Health Policy, Institute of Health Policy Studies, University of California, San Francisco, California JOAN MAXWELL, Senior Associate, Greater Washington Research Center, Washington, D.C. MARGARET A. MCMANUS, Health Policy Consultant, Washington, D.C. MARIE MEGLEN, Director, Bureau of Maternal and Child Health, South Carolina Depatl~ent of Health and Environmental Control, Columbia, South Carolina MARY PEOPLES, Assistant Professor, Department of Maternal and Child Health, School of Public Health, University of North Carolina at Chapel Hill, Chapel Hip, North Carolina BEATRICE l. SELWYN, Research Assistant Professor in Epidemiology, School of Public Health, University of Texas, Houston, Texas 1V

OCR for page R1
JOE LEIGH SIMPSON, Professor of Obstetrics and Gynecology and Head, Section of Suntan Genetics, Prentice Women's Hospital and Maternity Center, Northwestern University Medical Center, Chicago, Illinois STEVEN SMOOKLER, Assistant Dean for Special Programs, School of Medicine, Case Western Reserve University, Cleveland, Ohio SUSAN WILNER, Pew Fellow, Institute of Health Policy Series, University of California at San Franasco, San Francisco, California Contributed Papers HEINZ W. BE~NDES, Director, Epidemiology and Biometry Research Program, National Institute of Ch]d Health and Human Development, Bethesda, Maryland NAOMI BRESLAU, Associate Professor of Epidemiology and Community Health, School of Medicine, Case Western Reserve University, Cleveland, Ohio AMY FINE, Project Director, Child Health Outcomes Project of the University of North Carolina, Washington, D.C. STEPHEN G. GABBE, Professor of Obstetrics, Gynecology and Pediatrics, and Director, lerrold R. Golding Division of Fetal Medicine, University of Pennsylvania, Philadelphia, Pennsylvania KENNETH G. JOHNSON, Director, Health Services Research Center, The Kingston Hospital, Kingston, New York SAMUEL S. KESSEL, Chief, Research and Training Branch, Division of Maternal and Child Health, Department of Health and Human Services, Washington, D.C. MARK KLEB~OFF, Medical Staff Fellow, Epidemiology and Biometry Research Program, National Institute of Child Health and Human Development, Bethesda, Maryland MILTON KOTELCHUCK, Assistant Professor of Health Policy, Department of Social Medicine and Health Policy, Harvard MecTical School, Boston, Massachusetts MORTON LEBOW, Administrator for Public Affairs, Amencan College of Obstetricians and Gynecologists, Washington, D. C. DAVID SAL~VER, Professor of Health Policy and Management, School of Hygiene and Public Health, Johns Hopkins University, Baltimore, Maryland JOHN SINCLA~, Professor of Pediatrics, Department of Pediatrics, McMasters University, Hamilton, Ontario LEON SPEROFF, Professor and Chairman, Department of Obstetrics and Gynecology, Case Western Reserve University, and Director, McDonald Hospital for Women, Cleveland, Ohio

OCR for page R1

OCR for page R1
Preface . V11

OCR for page R1
TABLE 1. Percentage of Nlery Low Birthweight (VLBW) and Low Birthweight (LBW) Live Births in Selected Developed Countries, 1980 Country VLBWa LBWb Austria 0.80 5.68 CanadaC 0.84 6.10 Denmark O.72 6.00 Federal Republic of Germany 0.71 5.51 German Democratic Republic 0.55& 6.19 Israel 0.99 7.16 Italy 0.83 6.71 Japan 0.39 5.18 New Zealand 0.65 5.27 Norway 0.59 3.25 Swedene 0.49 4 03 Switzerland 0.49 5.14 United Kingdom England and Walesf 0.77 6.79 Scotland 0.96 6.73 United States 1.15 6.84 al,SOO grams or less. May represent underestimates if infants weighing less than 500 grams are excluded. b2,500 grams or less. CData for 1979. Probably an underestimate due to a nonstandard definition of live births and late fetal deaths. eData for 1978. fMacfarlane A and Mugford M: Birth Counts, Statistics of Pregnancy and Childbirth, p. 14. London: Her Majesty Stationary Office, 1984. gMcIlwaine GM, Dunn F. Howat RCL, Smalls M, Wyllie MM, and MacNaughton MC: Perinatal Mortality Survey, Scotland, 1977-1981. Glasgow: University of Glasgow, 1983. SOURCE: United Nations: Demographic Yearbook 1981. New York, 1983. United States and other countries often limit the applicability of data collected abroad to the United States. Acknowledgments Funding was provided principally by the Commonwealth Fund, with additional sup- port from the Ford Foundation, the March of Dimes Birth Defects Foundation, the Na- tional Institute of Child Health and Human Development, and the National Research Council Fund. The support of these funding sources is gratefully acknowledged. In my role as chairman of the committee that developed this report, ~ also wish to express my gratitude to the many individuals who contributed so much to our debbera- tions. In particular, it was a privilege to be associated with such a hardworking and dedi- cated committee, whose members gave so generously and unreservedly of their time and energies. Similarly, the committee joins me in acknowledging our great appreciation and indebtedness to the staff of this study, especially the study's director, Sarah Brown. Without her support and exceptional efforts in our behalf, the work could not have been . . . V111

OCR for page R1
so successfully completed. The many contributions of Lorraine Klerman, a consultant to the study and the author of several papers for the project, are also gratefully acknowI- edged. And particular thanks go to Eve Nichols, the report editor, for her tireless atten- tion to countless details of both form and substance. We were also fortunate in benefitting from the substantial help and stimulation pro- vided by a number of thoughtful commissioned and contributed papers, the authors of which are listed at the beginning of the report. These authors also provided useful per- sonal insights for which we are thankful. Several components of the Department of Health and Human Services provided valuable assistance in data analysis, in locating various materials needed by the committee, and in providing helpful commentary. We extend particular thanks to Vince Hutchins and Samuel Kessel within the Division of Maternal and Child Health; Joel Kleinman, Jacob Feldman, Paul Placek, Selma Taffel, Robert Hartford, and Mary Grace Kovar of the National Center for Health Statistics; and Heinz Berendes, Mark Klebanoff, Sumner Yaffe, Wendy Baldwin, and Charles Lowe of the National Institute of Child Health and Human Development. Many other individuals played an important role in the committee's deliberations by providing information, critical analysis, advice, and reviews of draft material. In particu- lar, we gratefully recognize the help provided by Robert Bragonier, Alexander Burnett, John Carl, Frederick Frigoletto, Phyllis Freeman, Steven GorUnaker, Asta Kenney, Mary Lou Moore, Merry-K Moos, Elena Nightingale, Anthony Robbins, Sara Rosenbaum, Anne Rosewater, Lisbeth Schorr, Steven Warsof, and Ronald Williams. RICHARD E. BEHRMAN, M.r). Chairn^.an K

OCR for page R1

OCR for page R1
Contents Summary and Recommendations . . . . . . . . . . . . . . . . . . PART I: Definitions, Risk Factors, and Trends I. The Significance of Low B~rthweight. 2. Etiology and Risk Factors. 3. Trends in Low Birthweight . PART Il.: Reducing the Incidence of Low Birthweight An Overview of Pro~sing Interventions Planning for Pregnancy The Effectiveness of Prenatal Care. Ensuring Access to Prenatal Care Improving the Content of Prenatal Care 4. 5. 6. 7. 8. 9. A Public Information Program 10. Prenatal Care and Low Birthweight: Effects on Health Care Expenditures. APPENDIXES A. Risk Factors Associated with Tow Birthweight . B. Data on Selected Low Birthweight Trends (Supplement to Chapter 3) . C. A Summary of Three Prematurity Prever~hon Programs. D. Notes on National Data Available to Study Low B~rthweight Trends and to Monitor Related Programs Index ma 21 46 94 115 119 132 150 175 202 212 241 252 266 275 279

OCR for page R1