Publication: Low Birth Weight

• Behrman, Richard E.

In this issue of The Future of Children, we focus on the
seemingly intractable problem of preventing death and
disability in infants as a result of being born too soon at
low birth weight. This topic is important because (1) low
birth weight results in a significant loss of life—with the
years of unfulfilled potential that early death represents
for each child and for society; (2) many surviving infants
sustain residual injuries that often tragically involve the
central nervous system; (3) the children and their families
often endure pain and suffering; and (4) there are
substantial financial costs involved. Over the past three
decades it had been hoped that a number of health and
welfare programs, whose primary objectives were to provide
needed medical services to pregnant women (such as prenatal
care) or to ameliorate harmful effects of poverty on
children (such as WIC), would also, coincidentally, prevent
the onset of most preterm labor and delivery. This has not
occurred. Therefore, based on current knowledge, further
interventions are needed. These should include providing
women of reproductive age with additional health services
before pregnancy. Because cigarette smoking during
pregnancy significantly increases the likelihood of having
a moderately low birth weight baby, there also should be
intensive programs to discontinue smoking during pregnancy.
Programs directed at discouraging children and adolescents
from starting to smoke would also have a beneficial effect
on reducing the low birth weight rate.

In addition to these measures, a significantly greater
research priority should be given to investigating the
mechanisms controlling the onset of labor. Further,
two-fold black to white (and Asian) racial differences
persist in the prevalence of preterm labor, low birth
weight, and infant mortality, and these outcomes are not
adequately explained by socioeconomic or lifestyle
variables. Consequently, particular attention should be
given to possible biological factors that might contribute
to the increased vulnerability of black women to having the
premature onset of labor. It is our hope that by redirecting
attention to this subject, further progress can be made in
reducing preterm delivery of low birth weight infants early
in the 21st Century.

The articles presented here summarize knowledge and
experience in selected areas that we believe are relevant
to improving public policies in the United States that have
an impact on infant mortality and morbidity. We hope the
information and analyses these articles contain will
further understanding of the important issues and thus
contribute to reasonable changes in policies which will
benefit children.