Factors influencing perinatal outcomes.

Important pregnancy outcomes include stillbirth and neonatal mortality, long-term neurologic handicap, and maternal mortality. Research conducted with the support of NICHD and other agencies in the last four decades has provided us with the ability to substantially improve many of these outcomes. In fact, in recent years, in the U.S. and other developed countries, childbirth has become a relatively safe undertaking for the mothers, and the vast majority of infants are born healthy and survive. In many developing countries, the risk of each of the adverse outcomes mentioned above is increased 10- to 100-fold compared to U.S. rates, with many of the differences explained by inadequately organized healthcare systems and low levels of health expenditures. At present, we have the knowledge to substantially reduce adverse pregnancy outcomes throughout the world; so far we have not had the will.