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584S Am J Clin Nutr 2007;85(suppl):584S–90S. Printed in USA. © 2007 American Society for Nutrition
LOW BIRTH WEIGHT IN THE UNITED STATES 585S
FIGURE 2. Incidence of preterm birth in the United States, 1981–2002. Source: National Vital Statistics Report (10).
586S GOLDENBERG AND CULHANE
FIGURE 4. Temporal changes in all preterm births and those resulting from
FIGURE 5. Approximate prevalence of cerebral palsy per 1000 births by
ruptured membranes, medically indicated reasons, and spontaneous preterm
birth weight and gestational age.
birth, United States, 1989 –2000. Source: adapted from Ananth et al (11).
follow premature rupture of the membranes or spontaneous pre- same group of infants approaches 80%. Improvement in survival
term labor, regardless of whether the delivery ultimately is vag- over the past decades for infants between born weighing between
TABLE 1
Cerebral palsy (CP) in infants weighing 쏝1000 g at birth
n % n n n
1960 20 000 1 200 16 32
1985 20 000 40 8000 640 1280
2000 20 000 80 16 000 1280 2560
1
Assuming an 8% incidence in survivors consistently over time.
2
Assuming a 16% incidence in survivors consistently over time.
and mycoplasma hominis are the 2 most common organisms, but suggests that the relation between BMI and preterm birth is
쏜30 different bacteria have been identified. Many of these or- mediated through cervical length, in that women who are over-
ganisms are components of a chronic vaginal infection called weight and obese tend to have longer cervices, which seem to
bacterial vaginosis, a common condition associated with a 2-fold protect against spontaneous preterm birth (19).
increase in preterm birth. About 85% of spontaneous preterm Several interesting observations have related various risk fac-
births of fetuses weighing 쏝1000 g are thought to be caused by tors to growth restriction mediated by maternal BMI. For exam-
an intrauterine infection, but few of the later preterm births are ple, higher BMIs appear to protect the fetus against the effect of
associated with this condition. Many attempts have been made to smoking on growth restriction (27). Similarly, higher BMIs pro-
reduce preterm birth by using antibiotics, either in the prenatal tect the fetus from the effect of maternal stress on growth restric-
SUMMARY
STRATEGIES USED TO REDUCE LOW BIRTH WEIGHT
In summary, the issue of LBW, and especially its preterm birth
Many other strategies have been used in an attempt to reduce component, has proven to be one of the most difficult pregnancy-
LBW (34). These include a general increase in prenatal care and related issues to address. Although survival has improved, the
many of its components. Home uterine contraction monitoring, proportion of births born before term continues to increase and
for example, has not generally led to any decrease in preterm the rate of disability among the preterm survivors has not de-
birth and often is associated with an increase in the use of various creased. Continued research aimed at reducing the preterm birth
interventions that by and large have not been effective (34, 36). rate and disability among survivors is crucial if we are to achieve
Programs aimed at reducing adverse health behaviors, such as the substantial improvements in pregnancy outcome in the United
use of drugs, alcohol, or tobacco, have by and large not had a States.
major effect on reducing preterm birth or growth restriction (34).
We should emphasize here, however, that tobacco use is more RLG performed the literature review, presented the data at the conference,
distinctly associated with growth restriction than with preterm and wrote the first draft of the paper. JFC helped to conceptualize the project,
birth (37), and it is likely that the recent decline in tobacco use reviewed the data before presentation, and edited both the presentation and
the paper. Neither of the authors had any financial interest or conflict of
during pregnancy is associated with an overall increase in birth
interest with the study.
weight. Many other interventions such as bed rest, use of anti-
biotics to treat infection, home uterine activity monitoring to
20. Iams JD, Goldenberg RL, Meis PJ, et al. The length of the cervix and the 32. Oakley GP. Folic acid-preventable spina bifida and anencephaly. JAMA
risk of spontaneous premature delivery. N Engl J Med 1996;334:567–72. 1993;269:1292–3.
21. Goldenberg RL, Goepfert AR, Ramsey PS. Biochemical markers for the 33. Ceesay SM, Prentice AM, Cole TJ, et al. Effects on birth weight and
prediction of preterm birth. Am J Obstet Gynecol 2005;192(suppl):S36 – perinatal mortality of maternal dietary supplements in rural Gambia: 5
46. year randomised controlled trial. BMJ 1997;315:786 –90.
22. Goldenberg RL, Hauth JC, Andrews WW. Intrauterine infection and 34. Goldenberg RL, Rouse DJ. The prevention of premature birth. N Engl
preterm delivery. N Engl J Med 2000;342:1500 –7. J Med 1998;339:313–20.
23. Romero R, Gomez R, Chaiworapongsa T, Conoscenti G, Kim JC, Kim
35. Kramer MS. Maternal nutrition and adverse pregnancy outcomes: les-
YM. The role of infection in preterm labour and delivery. Paediatr
Perinat Epidemiol 2001;15(suppl):41–56. sons from epidemiology. Nestle Nutr Workshop Ser Pediatr Program
24. Goldenberg RL, Culhane JF. Infection as a cause of preterm birth. Clin 2005;55:1–10 discussion 11–5.
Perinatol 2003;30:677–700. 36. Dyson DC, Danbe KH, Bamber JA, et al. Monitoring women at risk for
25. Wen SW, Goldenberg RL, Cutter GR, Hoffman HJ, Cliver SP. Intra- preterm labor. N Engl J Med 1998;338:15–9.
uterine growth retardation and preterm delivery: prenatal risk factors in 37. Kramer MS. Determinants of low birth weight: methodological assess-
an indigent population. Am J Obstet Gynecol 1990;162:213– 8. ment and meta-analysis. Bull World Health Organ 1987;65:663–737.
26. Hendler I, Goldenberg RL, Mercer BM, et al. The Preterm Prediction 38. Gyetvai K, Hannah ME, Hodnett ED, Ohlsson A. Tocolytics for preterm
Study: Association between maternal body mass index (BMI) and spon- labor: a systematic review. Obstet Gynecol 1999;94:869 –77.
taneous preterm birth. Am J Obstet Gynecol 2005 Mar;192:882-6. 39. Meis PJ, Klebanoff M, Thom E, et al for the National Institute of Child
27. Cliver SP, Goldenberg RL, Cutter GR, Hoffman HJ, Davis RO, Nelson Health and Human Development Maternal–Fetal Medicine Units Net-
KG. The effect of cigarette smoking on neonatal anthropometric mea- work. Prevention of recurrent preterm delivery by 17 alpha-
surements. Obstet Gynecol 1995;85:625–30. hydroxyprogesterone caproate. N Engl J Med 2003;348:2379 – 85.
28. Cliver SP, Goldenberg RL, Cutter GR, et al. The relationships among
40. da Fonseca EB, Bittar RE, Carvalho MHB, Zugaib M. Prophylactic
psychosocial profile, maternal size, and smoking in predicting fetal
administration of progesterone by vaginal suppository to reduce the
growth retardation. Obstet Gynecol 1992;80:262–7.
29. Goldenberg RL, Hauth JC, DuBard MB, Copper RL, Cutter GR. Fetal incidence of spontaneous preterm birth in women at increased risk: a
randomized placebo-controlled double-blind study. Am J Obstet Gy-