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Preventing l:~ow Birthweight ~ Summary ~ 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

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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 Engineering, and the Institute of Medicine. 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 proce- dures approved by a Report Review Committee consisting of members of the National Academy of Sciences, the National Academy of Engineering, and the Institute of Medicine. 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's 1863 congressional charter responsibility to be an adviser to the federal govern- ment and its own initiative in identifying issues of medical care research, and education. Library of Congress Catalog Card Number 85-60083 International Standard Book Number 0-309-03535-X Text prepared by Eve K. Nichols Cover photo by Susie Fitzhugh for Children's Hospital National Medical Center, Washington, D.C. The full report on which this summary is based is available for sale from the National Academy Press at the above address. (Preventing Low Birthweight, 284 pages) Copyright ~ 1985 by the National Academy of Sciences No part of this book may be reproduced by any mechanical, photographic, or electronic process or in the form of a phonographic recording, nor may it be stored in a retrieval system, transmitted, or otherwise copied for public or private use, without written permission from the publisher, except for the purposes of official use by the United States Government. First Printing, January 1985 Second Printing, May 1985 Third Printing, January 1986 Fourth Printing, August 198 7 Fifth Printing, November 19 87 Sixth Printing, September 1988 Seventh Printing, November 1989 Printed in the United States of America

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Committee to Study the Prevention of Low Birthweight RICHARD E. BEHRMAN, Chairman, Committee to Study the Prevention of Low Birthweight, Institute of Medicine, and Dean, School of Medicine, Case Western Reserve University, Cleveland, Ohio JEFFREY E. HARRIS, Associate Professor, Department of Economics, Massachusetts Institute of Technology, Cambridge, Massachusetts, and Clinical Associate, Massachusetts General Hospital, Boston, Massachusetts CALVIN I. HOBEL, Professor of Obstetrics, Gynecology and Pediatrics, School of Medicine, University of California at Los Angeles, and Director, Maternal-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 KLEIN, President, American College of Obstetricians and Gynecologists, and Professor of Gynecology and Obstetrics, Emory University School of Medicine, Atlanta, Georgia MARIE C. MCCORMICK, Assistant Professor of Pediatrics, 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, Department of Maternal and Child Health, School of Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina JOHN T. QUEENAN, Professor and Chairman, Department of Obstetrics and Gynecology, Georgetown University Hospital, Washington, D.C. JULIUS B. RICHMOND, Director, Division of Health Policy Research and Education, and John D. MacArthur Professor of Health Policy and Management, Harvard University, Boston, Massachusetts JUDITH P. ROOKS, President, American College of Nurse-Midwives, Portland, Oregon SAM SHAPIRO, 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 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 . . .

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STEPHANIE C. BRUGLER, Research Assistant, Division of Health Promotion and Disease Prevention EVE K. NICHOLS, Editor, Division of Health Promotion and 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 The authors of the many commissioned and contributed papers used by the committee in developing this statement are listed in the full report, of which this is only a summary. 1V

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Contents Introduction The Low Birthweight Problem Causes of Low Birthweight Planning for Pre~nanev The Impact of Prenatal Care Ensuring Access to Prenatal Care Improving the Content of Prenatal Care A Public Information Program References v 15 18 21 27 35 36

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