Preventing Low Birthweight -- Copyright -- PREFACE -- ACKNOWLEDGMENTS -- Contents -- SUMMARY AND RECOMMENDATIONS -- ETIOLOGY AND RISK FACTORS -- TRENDS IN LOW BIRTHWEIGHT -- AN OVERVIEW OF PREVENTIVE APPROACHES -- PLANNING FOR PREGNANCY -- ENSURING ACCESS TO PRENATAL CARE -- A System of Accountability -- IMPROVING THE CONTENT OF PRENATAL CARE -- Programs Complementary to Prenatal Care -- Encouraging Change in Prenatal Care -- Research Needs -- A PUBLIC INFORMATION PROGRAM -- COST ISSUES -- PART I DEFINITIONS, RISK FACTORS, AND TREND -- Chapter 1 The Significance of Low Birthweight -- CURRENT CONCEPTS OF FETAL GROWTH -- BIRTHWEIGHT AND INFANT MORTALITY -- Postneonatal Mortality -- Effect of Gestational Age and Other Risk Factors -- Current Decline in Neonatal Mortality -- LOW BIRTHWEIGHT AND MORBIDITY -- Neurodevelopmental Handicaps -- The Risk of Congenital Anomalies -- Respiratory Tract Conditions -- Complications of Neonatal Care -- Nonspecific Morbidity -- Injury -- Use of Health Services -- Family Function -- Financial Stress -- Overall Contribution of Low Birthweight To Morbidity -- Decreasing Mortality: the Effect on Morbidity -- SUMMARY -- REFERENCES AND NOTES -- Chapter 2 Etiology and Risk Factors -- ETIOLOGY -- Prematurity -- Intrauterine Growth Retardation (IUGR) -- RISK FACTORS: AN OVERVIEW -- DEMOGRAPHIC RISKS -- Race -- Age -- Socioeconomic Status -- MEDICAL AND OBSTETRIC RISKS -- Hypertension/Preeclampsia -- Diabetes -- Obstetric History -- Multiple Pregnancy -- Infections -- NUTRITION -- BEHAVIORAL AND ENVIRONMENTAL RISKS -- Smoking -- Alcohol -- IATROGENIC RISKS -- EVOLVING CONCEPTS OF RISK -- Stress -- Uterine Irritability -- Cervical Changes -- Inadequate Plasma Volume Expansion -- Progesterone Deficiency -- RISK ASSESSMENT -- Screening for Obstetric Risk -- Strengths and Limitations -- Improving Risk Assessment -- CONCLUSIONS.

References -- Chapter 3 Trends in Low Birthweight -- OVERALL TRENDS IN LOW BIRTHWEIGHT RATES -- THE COMPOSITION OF LOW-WEIGHT BIRTHS -- SOCIODEMOGRAPHIC CHARACTERISTICS -- PREGNANCY HISTORY -- PRENATAL CARE -- ANALYSIS OF 1981 SINGLE LIVE BIRTHS IN THE UNITED STATES -- CONCLUSIONS -- References and Notes -- PART II REDUCING THE INCIDENCE OF LOW BIRTHWEIGHT -- Chapter 4 An Overview of Promising Interventions -- PROMISING STRATEGIES -- NATIONAL DIRECTION FOR AN NATIONAL PROBLEM -- References and Notes -- Chapter 5 Planning for Pregnancy -- PREPREGNANCY RISK IDENTIFICATION AND REDUCTION -- ENLARGING THE CONTENT OF HEALTH EDUCATION -- THE ROLE OF FAMILY PLANNING IN REDUCING LOW BIRTHWEIGHT -- Unmet Need for Family Planning -- SUMMARY -- References and Notes -- Chapter 6 The Effectiveness of Prenatal Care -- ISSUES IN STUDYING THE EFFECTS OF PRENATAL CARE -- Research Design -- Defining Prenatal Care -- Validity of Data -- Control Variables -- Selection Bias -- REVIEW OF STUDIES OF PRENATAL CARE EFFECTS -- Results of Studies Using Large Data Bases -- Results of Program Evaluations -- CONCLUSIONS -- References and Notes -- Chapter 7 Ensuring Access to Prenatal Care -- WHO RECEIVES INADEQUATE PRENATAL CARE? -- Time Trends -- WHY DO SOME WOMEN OBTAIN INADEQUATE PRENATAL CARE? -- FINANCIAL CONSTRAINTS -- MATERNITY CARE PROVIDERS -- Obstetrician-Gynecologists -- Nurse-Midwives and Obstetrical Nurse Practitioners -- INSUFFICIENT PRENATAL CARE SERVICES -- WOMEN'S EXPERIENCES, ATTITUDES, AND BELIEFS -- TRANSPORTATION AND CHILD CARE -- INCREASING THE CAPACITY FOR OUTREACH -- Outreach Personnel -- Outreach Through Program Links -- A SYSTEM OF ACCOUNTABILITY AND RESPONSIBILITY -- References and Notes -- Chapter 8 Improving the Content of Prenatal Care -- CARE FOR ALL PREGNANT WOMEN -- Care For Women at Risk of Preterm Delivery.

Care for Women at Risk of Intrauterine Growth Retardation -- PROGRAMS COMPLEMENTARY TO PRENATAL CARE -- Smoking Reduction Programs -- Prenatal Nutrition Intervention: WIC -- Stress and Fatigue Alleviation -- ENCOURAGING CHANGE IN PRENATAL SERVICES -- RESEARCH NEEDS -- Describing the Current Content -- Research on Individual Care Components -- Clinical Topics -- Behavioral and Environmental Topics -- Research on Combinations of Interventions -- SUMMARY -- References and Notes -- Chapter 9 A Public Information Program -- CONDITIONS FOR SUCCESS -- Social Support -- Consistency of Effort -- Use of Multiple Mass Media -- Audience Definition and Message Development -- Quality of Materials -- A PUBLIC INFORMATION PROGRAM ON LOW BIRTHWEIGHT PREVENTION -- Program Objectives and Audience -- Messages -- Information Channels -- Leadership and Organizational Structure -- References -- Chapter 10 Prenatal Care and Low Birthweight: Effects on Health Care Expenditures -- OVERVIEW OF THE ANALYSIS -- Target Population -- Unit Cost of Prenatal Care -- Total Cost of Prenatal Care -- Costs of Care of Low-Weight Births -- Estimated Cost Savings -- Additional Assumptions and Comments -- DESCRIPTION OF COSTS -- Prenatal and Delivery Costs -- Initial Hospitalization Costs -- Rehospitalization Costs -- Long-Term Morbidity Costs -- RESULTS OF THE COST COMPARISON -- New Prenatal Care Expenditures -- Savings in the Cost of Caring for Low Birthweight Children -- Overall Cost Savings -- SUMMARY -- References and Notes -- APPENDIXES -- Appendix A Risk Factors Associated with Low Birthweight -- References and Notes -- Additional Reading On Risks Associated with Low Birthweight -- Appendix B Data On Selected Low Birthweight Trends -- Appendix C A Summary of Three Prematurity Prevention Programs.

Appendix D Notes On National Data Available To Study Low Birthweight Trends and To Monitor Related Programs -- Data Sources -- Data Needs -- References -- INDEX.