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Index A Abortion, 61-62, 126, 127 Abruptio placentae, 61 Accountability, 10-12, 168-171 Age family planning and, 125, 127-129 infant mortality and, 30 low birthweight rates and, 99-102, 259-261 prenatal care and, 139, 151-152, 161, 168 risk factors, 52-53, S6-59, 66, 258 Alcohol, 69 American Academy of Family Practice, 191 American College of Nurse-Midwives, 191 American College of Obstetricians and Gynecologists (ACOG), lS9, 191, 192, 194 American Public Health Association, 191 Appropriate for gestational age (AGA) infants, 24, 29 Asphyxia, 32 Attributable risk, 27, 29, 36-37, 241-248 B Bacter~uria, 63 Behavioral and environmental risks description of, 67-69 detection and management, 178 intervention programs, 183-190 research needs, 195-196 Behavioral problems, 36 279 Black infants. See Race Bowman Gray School of Medicine Prevention of Prematurity Program, 192 British Perinatal Mortality Survey. ~8 C Centers for Disease Control (CDC), 276, 277 Cerebral intraventricular hemorrhage, 32 Cervical assessment, 73-74 Cervical cerclage, 74 Cervical changes, 73-74 Cesarean section, 69-70, 181 Child abuse, 34, 35 Child care, 166 Childbirth education classes, 179-180 Chlamydia trachomatis, 64 Collaborative Postnatal Study, 54 Community Health Centers (CHCs), 143-144 Congenital anomalies, 32-33, 36, 37, 60, 63, 69 Contraceptives, 125, 127-129 Cost analysis assumptions, 219-220 components of, 214-220 cost descriptions, 220-224 cost savings estimates, 218-219, 228-232 limitations of, 212-214 low-weight infant care, 217-218 prenatal care, 215-217, 220-221, 227-232 results, 224-232

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280 summary, 16-17, 232-233 target population, 214-215, 225-226 Counseling, 119-122, 178, 183-186 Cytomegalovirus infection, 63 D Data systems, 275-278 Deaths. See Infant mortality Delivery costs, 220-221 Demographic risks age-related, 52-53, 56-59, 66, 99-102, 259-261 low birthweight rates and, 98-103, 106-108 race-related, 24, 26-27, 30, 52-56, 66, 98-103, 106-108, 253, 257-259, 262 socioeconomic status, 53, 57-58, 66, 261 Department of Health and Human Services, 118, 169, 194, 20 6 Developmental problems, 32, 37 Diabetes mellitus, 60-61, 120 Dietary supplements, 66-67 Division of Maternal and Child Health (DMCH), 156, IS7, 191 E Education. See Maternal educational attainment Educational programs patient, 122-125, 178-181' 184-187 prepregnancy planning, 122-124 provider, 121, 123, 181, 186, 192 smoking reduction, 184-187 See also Counseling; Public information program Employment status, 71, 190 Etiology data limitations, 46 intrauterine growth retardation, 48-49 prematurity, 46-48 summary, 2-3 F Family function, 35-36 Family life education, 124-125 Family planning, 124-129 Family Planning Assistance Program (Title X), 127-128 Fatigue, 189-193 Fetal growth concepts, 23-24 Financial constraints, 153-157, 170-171 Financial stress, 36 French Prematurity Prevention Program, 270-272 G Genitourinary infection, 63-65 Gestational age birthweight classification and, 21-24 iatrogenic prematurity and, 69. 70 morbidity and, 32 mortality and, 29-30 prenatal care and, 183 smoking and, 68 Health care costs. See Cost analysis Health Care Financing Administration (ECFA), 156, 157, 159 , Bealth department services, 163, 169 Health education. See Educational programs Health insurance, 154, 192-193 Health maintenance organizations (HMOs), 141 Health services, 34-35 Healthy Mothers, Healthy Babies Coalition, 204, 208-209 Hispanics, 55, 1-68. See also Race Hospital utilization, 34 Hospitalization costs, 217-218, 221-223, 228-230 Hypertension, 59, 71, 74 Hypoglycemia, 61 I Iatrogenic risks, 69-70, 181 Improved Pregnancy Outcome (IPO) Projects, 142, 143 Induced labor, 69-7O, 181

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281 Infant mortality family planning and, 124-125 medical and obstetric risks, 59, 62 neonatal, 30-31 nutrition and, 65-66 postneonatal, 29 risk factors, 1-2, 24-31, 37-38 Infections, 63-65, 74 Initial hospitalization costs, 217-218, 221-222, 228-229 Injury, 34 Intendedness of pregnancy, 125-127 Intensive care cost estimates, 221-222, 228-229 morbidity and, 33, 37 mortality and, 31 utilization of, 34 Interpregnancy interval, 103, 106, 125 Intrauterine growth retardation (UGR) alcohol use and, 69 etiology, 48-49 medical and obstetric risks, 59-61, 63 plasma volume factors, 74 prenatal care and, 183 risk assessment, 75-77, 82 smok ing and, 68 stress factors, 71-72 Intrauterine infection, 63 Iso~mmunization, 61 L Labor, 46-47, 64, 72-74 Long-term morbidity costs, 217, 218, 224, 230-231 Los Angeles Prematurity Prevention Program, 268-270 Low birthweight concept development, 21-23 conclusions and recommendations, 118 fetal growth concepts and, 23-24 morbidity and, 1, 31-37 mortality and, 1-2, 24-31, 37-38 overview of interventions, 115-118 preventive strategies, 4-S, 115-118 significance, 21-45 trends, 94-112 Low birthweight rates analytical approach, 94-95 composition of, 96-98 general trends, 95-96, 253-2S6 obstetric history and, 102-103, 106 prenatal care and, 106-108, 264, 265 research needs, 111-112, 275-278 risk reduction estimate, 108 sociodemographic character) sties, 98-102 state data, 252-265 scary of trends, 3-4, 110-111 Malpractice, 159-160 March of Dimes Multicenter Prevention of Preterm Delivery Program, 266-268 Mar ital status, 58, 66, 101, 125-126, 152 Mass media, 203-204, 207, 209 Maternal educational attainment infant mortality and, 30 low b ir thweight r ates and, 100-102, 261, 262 low birthweight risks, 53, 56, 66, 261 Maternal weight and height, S6-58, 66, 67, 71, 183 Maternity and Infant Care (MIC) Pro Sects, 142 Maternity leave, 190 Medicaid, 154-159, 170, 221, 223 Medical and obstetr ic r isks diabetes, 60-61, 120 hyper tension/preec lampsia, 5 8, 59, 71, 74 Infection, 63-65, 74 multiple pregnancy, 62, 189 obstetric history, 61-62 Medical service utilization, 34-35 Moderately low birthweight (MLBW}, 96-97, 217, 223, 229 Morbidity costs, 217, 218, 224, 230-231 medical and obstetric r isks and, 60, 62, 63, 70 nonspecific, 33 risk factors, 1, 26, 31-37 Mortality. See Infant mortality Multiple pregnancy, 62, 189 Mycoplasma infection, 64

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282 N National Center for Health Statistics (NCHS), 206, 274-278 National Natality Surveys (NNS), 276-278 Neonatal intensive care complications, 33 Neurodevelopmental problems, 26, 31-32 Nurse-midwives, 144, 158, 160-161 Nurse practitioners, 160, 161 Nurses Association of the American College of Obstetricians and Gynecologists, 191 Nutrition, 65-67, 183, 187-189 o Obstetric history low birthweight rates and, 102-103, 106 prepregnancy planning and, 120-121 risk factors, 54-55, 61-62, 76-77 Obstetrical Access Pilot Project (OB Access), 144-145, 155-156, 221 Obstetrician-gynecologists, 157-160 Office on Smoking and Health, 204-205 Outreach strategies, 166-168 Oxytocin, 69, 72-73 p Parenting behaviors, 35-36 Pediatricians, 121, 158 Perinatal intensive care. See Intensive care Physical stress, 71, 189 Physician utilization, 34 Physicians. See Providers Planning. See Prepregnancy planning Plasma volume, 74 Plural births. See Multiple pregnancy Preeclampsia, 59 Pregnancy care. See Prenatal care; Prenatal care access; Prenatal care content Pregnancy dating, 177, 178, 183 Pregnancy history, 102-106 Pregnancy interval. See Interpregnancy interval Prematurity. See Preterm delivery Prematurity pr evens ion progr~n~c, 140-141, 192, 266-274 Prenatal care cost analysis, 215-217, 220-221, 227-232 family planning and, 126 low birthweight rates and, 106-108, 264, 265 risk factors, 53-54, 56 Prenatal care access accountability, 168-171 attitude factors, 164-166 barriers to, 153 conclusions and recommendations, 156-157, 159, 161, 167-171 financial constraints, 153-157, 170-171 governmental role, 168-171 maternity care providers, lS7-161 outreach strategies, 166-168 provider availability factors, 157-161 research needs, 167-170 service availability factors, 161-164 sundry, 7-12 transportation and child care factors, 166 utilization factors, 151-153 Prenatal care content conclusions and recommendations, 187-189, 193 intrauterine growth retardation prevention, 183 low birthweight prevention, 175-180 nutrition intervention, 187-189 preterm delivery prevention, 180-183 research needs, 193-197 smoking reduction program, 184-187 stress and fatigue alleviation, 189-190, 196 sugary, 12-15, 197 Prenatal care effectiveness analytical problems, 132-137 conclusions and recommendations, 145-147 literature review, 137-145 Prepregnancy planning conclusions and recommendations, 121-122, 124, 126, 128

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283 family planning, 124-129 health education activities, 122-124 research needs, 121-122 risk identification and reduction, 119-122 summary, 5-7, 129 P reterm delivery cervical change assessment, 73-74 demographic risk factors, 52, 57-58 etiology, 46-49 iatrogenic risks, 69-70, 181 medical and obstetric risks, 59-62, 64 nutrition and, 65 plasma volume factors, 74 prenatal care and, 180-183 progesterone deficiency factor, 74-75 rates of, 97-98 risk assessment, 75-77, 82 stress factors, 71-72 uterine irritability and, 72-73 Preventive approaches, 4-5, 115- 118. See also Prematurity prevention program; Prepregnancy planning Previous pregnancy history. See Obstetric history Progesterone, 46-47, 74-75 Providers counseling, 121, 184-187, 193 education of, 181, 186, 192 prenatal care provision, 157-161 utilization of, 34 Psychological stress, 72, 189 Public information program audience definition, 204 conclusions and recommendations, 206 conditions for success, 202-205 consistency factors, 203 elements of, 205-210 information channels, 207-208 message topics, 207-208 multiple media use, 203-204 objectives of, 205-206 organizational structure, 208-210 quality factors, 205 social support factors, 202-203 s~,Tmnary, 16 Public service announcements (PSAs), 204 - 205, 208 Pyelonephritis, 63 R Race family planning and, 125, 126 infant mortality and, 26-27, 30 low birthweight rates and, 98- 103, 106-108, 253, 257-259, 262 prenatal care and, 138-140, 143, 151, 152, 154, 155 risk factors, 24, 52-56, 66 Rehospitalization, 34 Rehospitalization costs, 217, 218, 223, 229-230 Relative risk, 27, 99-103, 106, 108, 241-248 Reproductive history. See Obstetric history Research needs infant morbidity, 37 low birthweight rate data, 111-112, 275-278 prenatal care access, 167, 170 prenatal care content, 186, 193-197 prepregnancy planning, 121-122 risk factors, 3, 56, 83-84 seminary, 15 Respiratory tract conditions, 33, 70 Risk assessment, 75-77, 82, 176-177, 180-181 Risk factors alcohol, 69 cervical changes, 73-74 conclusions and recommendations, 82-84 data limitations, 49-50 demographic, 52-58 grouping of, 50-52 iatrogenic prematurity, 69-70, 181 medical and obstetric, 58-65 nutrition, 65-67 overview, 241-248 plasma volume expansion inadequacy, 74 progesterone deficiency, 74-75 research needs, 3, 56, 83-84 smoking, 66-68 stress, 71-72 sunmlary of, 2-3 uterine irritability, 72-73 Risk reduction counseling, 119-122 Rubella virus infection, 63

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284 S Screening. ee Risk assessment Service provision, 161-164 Sex education, 123-124 Sexual intercourse, 73 Small for gestational age (SGA) infants, 24, 29, 32, 189 Smoking public information program, 202-205 reduction programs, 184-187 risk factors, 54, 58, 66-68 Sociodemographic characteristics, 98-102 Socioeconomic status (SES) family planning and, 125, 127 low birthweight rates and, 100 prenatal care and, 153-157, 161 risk factors, 53, 57-58, 66 Special Supplemental Food Program for Women, Infants and Children (WIC), 167 , 187-189 , 207 Stress, 36, 71-72, 189-190, 196 T Task force proposal, 169-170 Teenagers family planning and, 125, 127-129 low birthweight rates and, 99-100, 102 prenatal care and, 139, 151, 152, 161, 168 prepregnancy r isk counseling, 121 r isk factors, 52-53, 56-58, 66, 68 Term deliver ies, 52, 57-58, 62, 97-98 Th ird-par ty r eimbursement. See Health insurance; Medicaid Title X program, 127-128 Tocolys is, 181 - 18 3 Transpor tation, 166 Ultrasonography, 178, 183 Unintended pregnancy, 125-127 University of California at San Francisco prematurity prevention program, 190 Urinary tract infection, 63-64 U.S. Commodity Supplemental Food Program, 188-189 Uterine irritability, 72-73, 182 V Very low birthweight cost of care and, 217, 222, 223, 229, 231 definition of, 23 morbidity and, 32-34, 36 mortality and, 27, 29, 31 rates of, 96-97 Vital Statistics Registration System (VSRS), 275-278 W Wantedness of pregnancy, 125-126 Working status, 71, 190 World Health Organization (WHO), 21-22