Low birth weight and preterm birth: the emerging importance of prevention.

This article on LBW and preterm birth was prepared for this issue, "Interdisciplinary Strategies for Prevention", recognizing its US focus in relation to a European audience. Although the pregnancy and infant health magnitude of the problem is greater in North America, its multifactorial nature and serious impacts are experienced worldwide. Emphasis has been placed on its high costs vis-à-vis neonatal mortality, childhood morbidity, and medical care expenditures for tertiary level management. Three preventive health care strategies, linked to an attractive sociobehavioral model, are presented. The model displays multiple risk factors and their interrelationships, including the pathophysiologic events that lead to LBW and preterm birth. Acknowledging the primacy of basic societal level changes, the strategies nonetheless are based in the health care services. They call for interdisciplinary interventions as a part of preconceptual and prenatal health care. Such approaches as reduction of stress and other risk behaviors, improved nutrition, family planning and social services as well as strengthening family and community support systems are suggested. In addition a secondary prevention strategy dependent on identification of pregnant women at high risk of LBW and preterm birth is described. Early recognition by patients and providers of signs of uterine irritability may enable prevention of preterm birth by prompt treatment with tocolytic agents. Evidence relevant to the effectiveness of the preconceptual and prenatal care interventions, insofar as it is available, is cited.