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  • Title: [Prevention of low birth weight].
    Author: Casanueva E.
    Journal: Salud Publica Mex; 1988; 30(3):370-8. PubMed ID: 3187735.
    Abstract:
    Low birth weight is a powerful predictor of infant mortality. Programs to prevent low birth weight must be based on detailed knowledge of its risk factors, but thus far the search for indicators of risk has not led to an overall strategy that permits prevention of low birth weight. Published works have emphasized some aspects of risk but have neglected study of the interrelations between different risk factors. Moreover, the most satisfactory indicators have not always been selected to represent the diverse processes involved. Research on risks associated with health services and nutrition exemplify these difficulties. For the study of low birth weight, research on health services has centered on prenatal surveillance, with the gestational age at the 1st visit or the number of visits the most frequent indicators. Prenatal care is studied by researchers because it is associated with other factors affecting the fetus through inadequate diet, such as poverty, stress, alcoholism, or smoking. These studies postulate that changes in the quality and amount of prenatal care will be associated with a decline in prevalence of low birth weight, independent of the conditions associated with inattendance at obstetric consultations. Indicators of prenatal surveillance have predictive value with respect to the probability of low birth weight, can be expressed numerically through the number of visits and gestational age at initiation, and can be obtained by auxiliary personnel. But they are inadequate indicators because the populations obtaining good prenatal care are biased by self-selection. Moreover, prenatal surveillance is considered primarily as an instrument of detection which does not necessarily lead to action in subjects at risk. Most nutritionally-focussed research on low birth weight has centered on energy reserves in studies conducted among populations in which malnutrition is common. The most frequently used indicators involve indirect evaluation of body composition. Energy reserves have predictive value for birth weight, can be expressed numerically, and are directly related to the weight of the infant so that modifications in the magnitude of the reserves are positively associated with a reduction in prevalence of low birth weight. Information on energy reserves can be collected by auxiliary personnel without costly equipment. Energy reserves have greater predictive value in malnourished populations and there is a threshold above which the association is lost. Although energy reserves are susceptible to modification, they are rarely tied directly to preventive or therapeutic actions. The adequacy of other risk factors as indicators to be used in programs to prevent low birth weight should be systematically assessed in a similar manner. A start is made in an annex to this work which summarizes the rationale for examining the social, family, and biological variables believed to be the most relevant.
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