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Preventing Low Birthweight ~ summary ~ INTRODUCTION Low birthweight is a major determinant of infant mortality in the United States. Infants weighing 2,500 grams (5.5 pounds) or less are almost 40 times more likely to die during their first 4 weeks of life than the normal birth- weight infant. In adclition, low birthweight survivors are at increased risk of health problems ranging from neurodevelopmental handicaps to lower respiratory tract conditions. To determine whether opportunities exist to reduce the incidence of Tow birthweight in this country, the Institute of Medicine convened an in- terdisciplinary committee in 1983 to study the causes and prevention of premature birth and intrauterine growth retardation, the twin contributors to low birthweight. The committee was asked to define those measures likely to be most effective in preventing low birthweight and to consider their costs in relation to the costs of caring for low birthweight infants. As backgrounctto such an analysis, the group was also asked to assess the relationship of Tow birthweight to mortality and morbidity, to review existing information on the physiological causes of Tow birthweight ancT the risk factors associated with it, and to examine trends over time. The committee concluded that the prevention of Tow birthweight could contribute significantly to a reduction in infant mortality in the United States and, more generally, to improved child health. Despite many unanswered questions about causation and the interplay of important risk factors, policy- makers and health professionals have enough information at present to intervene more vigorously to improve pregnancy outcome. Useful ap- proaches include placing greater emphasis on identifying and reducing risks before pregnancy, increasing the accessibility of early and regular high- quality prenatal care for all pregnant women, enriching the content of pre- natal care and endowing it with sufficient flexibility to meet the needs of both high- and low-risk women, and developing a long-term public information program to convey messages about ways to reduce low birthweight. All of these efforts should be supported by research activities that will increase their effectiveness. Progress in the directions recommended by the committee will require recognition of the low birthweight problem as an important national issue. This was partially achiever! in 1930, when the Surgeon General of the United States specified a reduction in the low birthweight rate as one of the objec