Reducing preterm and low birthweight rates in the United States: is psychosocial assessment the answer?

Abstract

Since the late 1970s, there has been no overall improvement in preterm and low birthweight rates in the United States (1). Instead, very low birthweight, low birthweight, and preterm rates in the United States and elsewhere have remained largely unchanged or they have increased during this period (1-3). These trends are a matter of considerable concern to public health in general and maternal and child health (MCH) in particular, as being born too small or too soon entails significant risks of early mortality and serious morbidity (2, 4-7). The majority of U.S. infant deaths occur to these infants and the smallest survivors have a markedly increased chance of long-term neurologic damage, cerebral palsy, mental retardation, sensory impairment, learning disabilities, school-related problems, and other disabilities or developmental delays (1,2,4-7). Moreover, the hospitalization, medical care, comprehensive follow-up, early intervention, mental health, special education, and other needed support-service costs associated with a preterm and low birthweight delivery are profound (5, 8-10). The gravity of the problem and the importance of reducing rates of low birthweight and preterm births has long been recognized in the United States. In 1985, the Institute of Medicine (IOM) published its seminal study, Preventing Low Birthweight, in which it identified low birthweight as a "major determinant of infant mortality" (5). As a means to reduce