The prevention of low birthweight and its sequelae.

BACKGROUND: Low birthweight and its components preterm birth and fetal growth retardation account for the vast majority of perinatal mortality and more than 50% of the long term neurologic morbidity.
METHODS: Historical trends and the effectiveness of various interventions designed to improve pregnancy outcomes associated with low birthweight were evaluated in an attempt to define which future research efforts might be useful.
RESULTS: Practices aimed at achieving a reduction in the low birthweight rate (the use of tocolytics, enhanced prenatal care, nutritional interventions) have not generally been successful or have not been widely utilized (smoking cessation programs). Practices aimed at improving low birthweight survival and reducing morbidity (group B streptococcus prophylaxis, maternal corticosteroids, surfactant use, newborn ventilation) have been responsible for most of the improvements in outcome.
CONCLUSION: Continued effort into discovering effective practices for reducing low birthweight, for understanding the most appropriate methods of implementing practices known to be effective in reducing low birthweight, and refinement of practices known to reduce mortality and long term handicap in low birthweight babies should be major foci of prevention research.