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Show who reported tobacco use had low birth weight infants compared to 5.4% of women who did not report use of tobacco. Reported use of alcohol during pregnancy is also associated with a higher incidence of low birth weight. Among Utah births during 1989-1997, 11.5% of women who reported alcohol use had a low birth weight infant compared to 5.9% among women who reported no alcohol use (Bureau of Vital Records, 1999a). Inadequate Prenatal Care Women who do not receive prenatal care are much more likely to have a low birth weight infant. Although the percentage of Utah mothers with no prenatal care has decreased from 2.1% in 1989 to 1.5% in 1997, birth certificate data for 1989-1997 indicate that mothers who received no prenatal care had much higher percentages of low birth weight infants (20.2%) than mothers who received prenatal care (5.9%). Low birth weight percentages are also significantly higher among women with inadequate prenatal care (late entry or inadequate visits); 6.3% of women with inadequate care had low birth weight births compared to 5.8% among women with adequate care (Bureau of Vital Records, 1999a). Recommendations Since little is known about effective strategies to prevent low birth weight (especially as it is associated with preterm birth), it will be difficult to achieve a reduction in rates. It has been noted that most interventions that have been developed to prevent preterm birth do not work, that the few that do only are effective on a small percentage of women who are at risk for preterm delivery (Goldenberg & Rouse, 1998). The following recommendations may assist health care providers and women of childbearing age to reduce risks associated with low birth weight: • All pregnant women should be encouraged to enter prenatal care early in their pregnancies to facilitate early identification of risk factors. • All pregnant women should be assessed during their first prenatal care visit to identify risks for adverse pregnancy outcomes, including health history, pregnancy history, their mother's pregnancy history, nutritional status, screening for alcohol, tobacco and other drug use, psychosocial history, including stress, depression, anxiety, and domestic violence. • Women at high risk for low birth weight need close monitoring and tracking by a qualified prenatal care provider with possible referral to a high risk obstetrical specialist and /or referral for case management and social support, which may include home health care and educational materials and information. > Pregnant women with chronic medical conditions need a medical provider with the necessary expertise to manage their obstetrical care concurrent with their medical condition. This may mean that one medical provider with the necessary expertise manages the obstetrical care along with the medical condition, or it may necessitate collaboration between an obstetrical specialist and a medical specialist for the particular medical condition, depending on its severity. • Pregnant women should be referred to appropriate ancillary services, such as Women, Infants and Children Nutrition Program (WIC), Medicaid, Family Employment Program (FEP), food stamps, child care, psychosocial support services, housing, and transportation resources. • For risk factors amenable to change, such as appropriate weight gain, smoking, and/or substance use, pregnant women need to be counseled and supported in their efforts to reduce risks. Women who smoke, use alcohol or other drugs should be referred to appropriate resources for treatment. • Early recognition and appropriate intervention of preterm labor by providers to reduce low birth weight births due to preterm delivery should be promoted. > Screening for and treating urinary and genital tract infections may reduce preterm labor. > Pregnant women should be educated about fetal kick counts, recognition of the signs and symptoms of preterm labor and the importance of follow-up with their health care provider if they occur. • The standards developed by the American Society for Assisted 44 |
