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Modifiable Risk Factors for Low Birth Weight and Their Effect on Cerebral Palsy and Mental Retardation

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Abstract

Objective: to estimate the effect of modifiable risk factors on low birth weight and two of its sequelae—cerebral palsy and mental retardation.

Methods: The population attributable risk percent (PARP) was used as a measure of effect. A literature search was conducted to determine estimates of the percent of CP and MR attributable to low birth weight. Data from the 1996–1997 Georgia Pregnancy Risk Assessment Monitoring System (PRAMS), a population based surveillance system, were used to estimate the percent of low birth weight attributable to modifiable risk factors. The PARP was calculated for smoking and unwanted conception.

Results: Unwanted pregnancy and smoking were statistically significant risk factors for LBW.

Four percent of all LBW births were attributable to unwanted pregnancy. If all unwanted pregnancies were prevented, 13% of cases of CP (27 cases per year in GA) and 14% of cases of MR (151 cases per year in GA) would be prevented.

In wanted or mistimed pregnancies, 6% of LBW births were attributable to smoking. If all smoking during wanted or mistimed pregnancy was prevented, an additional 2.5% (5 cases) of CP and an additional 0.8% (8 cases) of MR would be prevented in Georgia each year.

If all unwanted pregnancies and all smoking during wanted or mistimed pregnancies were prevented, 1692 LBW births could be prevented per year and the rate of LBW in Georgia would fall from 7.6% to 6.8%. Additionally, 32 cases of cerebral palsy and 159 cases of mental retardation could be prevented each year in Georgia.

Conclusions: The PARP approach is useful in estimating the benefit of evidence-based prevention services. Preventing unwanted pregnancy and smoking during pregnancy would substantially reduce the burden of cerebral palsy and mental retardation in Georgia.

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References

  1. Kiely JL, Brett KM, Yu S, Rowley DL. Low birth weight and intrauterine growth retardation. In: From data to action: CDC’s public health surveillance for women, infants, and children. CDC’s maternal and child monograph, 1994. Atlanta, GA: Centers for Disease Control and Prevention; 1994. p. 185–202.

    Google Scholar 

  2. Harper PA, Wiener G. Sequelae of low birth weight. Annu Rev Med 1965;16:405–20.

    Article  PubMed  CAS  Google Scholar 

  3. Baumgartner L. The public health significance of low birth weight in the USA, with special reference to varying practices in providing special care to infants of low birth weight. Bull World Health Organ 1962;26:175–82.

    PubMed  CAS  Google Scholar 

  4. Robinson NM, Robinson HB. A follow-up study of children of low birth weight and control children at school age. Pediatrics 1965;35:425–33.

    PubMed  CAS  Google Scholar 

  5. World Health Organization. Expert group on prematurity. Final report. Technical report, series 27. Geneva: World Health Organization; 1950.

  6. Croen LA, Grether JK, Selvin S. The epidemiology of mental retardation of unknown cause. Pediatrics 2001;107:E86.

    Article  PubMed  CAS  Google Scholar 

  7. Winter S, Autry A, Boyle C, Yeargin-Allsopp M. Trends in the prevalence of cerebral palsy in a population-based study. Pediatrics 2002;110:1220–5.

    Article  PubMed  Google Scholar 

  8. Boyle CA, Yeargin-Allsopp M, Doernberg NS, Holmgren P, Murphy CC, Schendel DE. Prevalence of selected developmental disabilities in children 3–10 years of age: the Metropolitan Atlanta Developmental Disabilities Surveillance Program, 1991. In: CDC Surveillance Summaries, April 19, 1996. Morbidity and Mortality Weekly Reports. 1996;45(No. SS-2).

  9. Pharoah PO, Cooke T, Rosenbloom L, Cooke RW. Effects of birth weight, gestational age, and maternal obstetric history on birth prevalence of cerebral palsy. Arch Dis Child 1987;62(10):1035–40.

    PubMed  CAS  Google Scholar 

  10. Mervis C, Decoufle P, Murphy CC, Yeargin-Allsopp M. Low birthweight and the risk for mental retardation later in childhood. Paediatr Perinat Epidemiol 1995;9(4):455–68.

    Article  PubMed  CAS  Google Scholar 

  11. Andrews H, Goldberg D, Wellen N, Pittman B, Struening E. Prediction of special education placement from birth certificate data. Am J Prev Med 1995;11(3 Suppl):55–61.

    PubMed  CAS  Google Scholar 

  12. McDermott S, Cokert AL, McKeown RE. Low birthweight and risk of mild mental retardation by ages 5 and 9 to 11. Paediatr Perinat Epidemiol 1993;7(2):195–204.

    PubMed  CAS  Google Scholar 

  13. Msall ME, Tremont MR. Measuring functional outcomes after prematurity: Developmental impact of very low birth weight and extremely low birthweight status on childhood disability. Ment Retard Dev Disabil Res Rev 2002;8:258–72.

    Article  PubMed  Google Scholar 

  14. Rantakallio P, von Wendt L. Prognosis for low-birthweight infants up to the age of 14: a population study. Dev Med Child Neurol 1985;27(5):655–63.

    Article  PubMed  CAS  Google Scholar 

  15. Kitchen WH, Yu VY, Orgill A, Ford GW, Rickards A, Astbury J, Ryan MM, Russo W, Lissenden JV, Bajuk B, Keith CG, Nave JR. Collaborative study of very-low-birthweight infants: outcome of two-year-old survivors. Lancet 1982;1(8287):1457–60.

    Article  PubMed  CAS  Google Scholar 

  16. Ellenberg JH, Nelson KB. Birth weight and gestational age in children with cerebral palsy or seizure disorders. Am J Dis Child 1979;133(10):1044–8.

    PubMed  CAS  Google Scholar 

  17. Gustavson KH, Hagberg B, Hagberg G, Sars K. Severe mental retardation in a Swedish county. II. Etiologic and pathogenetic aspects of children born 1959–1970. Neuropadiatrie 1997;8(3):293–304.

    Article  Google Scholar 

  18. Institute of Medicine Committee to Study the Prevention of Low Birthweight, Division of Health Promotion and Disease Prevention. Preventing low birthweight. Washington, DC: National Academy Press; 1985.

  19. Paneth N. The problem of low birth weight. Future Child 1995;5:19–34.

    Article  PubMed  CAS  Google Scholar 

  20. Buekens P, Klebanoff M. Preterm birth research: from disillusion to the search for new mechanisms. Paediatr Perinat Epidemiol 2001;15(Suppl 2):159–61.

    Article  PubMed  Google Scholar 

  21. Hogue CJR, Yip R. Preterm delivery: can we lower the black infant’s first hurdle? JAMA 1989;262(4):548–50.

    Article  PubMed  CAS  Google Scholar 

  22. Hogue CJR, Vasquez C. Toward a strategic approach for reducing disparities in infant mortality. Am J Public Health 2002;92:552–6.

    PubMed  Google Scholar 

  23. U.S. Department of Health and Human Services. Women and smoking: a report of the Surgeon General—2001. Chapter 3. U.S. Government Printing Office; 2001.

  24. Visscher WA, Feder M, Burns AM, Brady TM. Bray RM. The impact of smoking and other substance use by urban women on the birthweight of their infants. Subst Use Misuse 2003;38:1063–98.

    Article  PubMed  Google Scholar 

  25. U.S. Department of Health and Human Services. The health consequences of smoking: a report of the Surgeon General. Chapter 5. U.S. Government Printing Office, May 27; 2004.

  26. Breslau N, Paneth N, Lucia VC, Paneth-Pollak R. Maternal smoking during pregnancy and offspring IQ. Int J Epidemiol 2005;34:1047–53.

    Article  PubMed  Google Scholar 

  27. Drews CD, Murphy CC, Yeargin-Allsop M, Decoufle P. The relationship between idiopathic mental retardation and maternal smoking during pregnancy. Pediatrics 1996;97:547–53.

    PubMed  CAS  Google Scholar 

  28. Centers for Disease Control and Prevention. Smoking during pregnancy—United States, 1990–2002. MMWR 2004;53:911–5.

    Google Scholar 

  29. Peterson R, Clark KA, Hartmann KE, Melvin CL. Getting focused: missed opportunities for smoking interventions for pregnant women receiving Medicaid. Prev Med 2005;40:209–15.

    Article  Google Scholar 

  30. Hogue CJR. Consequences of unintended pregnancy. In: Brown SS, Eisenberg L, editors. The best intentions: unintended pregnancy and the well-being of children and families. Chapter 3. Washington, DC: National Academy Press; 1995. p. 50–90.

  31. Kost K, Forrest JD. Intention status of U.S. births in 1988: differences by mothers’ socioeconomic and demographic characteristics. Fam Plann Perspect 1995;27(1):11–7.

    Article  PubMed  CAS  Google Scholar 

  32. Henshaw SK. Unintended pregnancy in the United States. Fam Plann Perspect 1998;30(1):24–29, 46.

    Google Scholar 

  33. D’Angelo D, et al. Measuring unintended pregnancy: are women who report mistimed and unwanted pregnancies different? Atlanta: Division of Reproductive Health, CDC; 2001.

  34. Hellerstedt WL, Pirie PL, Lando HA, Curry SJ, McBride CM, Grothaus LC, Nelson JC. Differences in preconceptional and prenatal behaviors in women with intended and unintended pregnancies. Am J Public Health 1998;88(4):663–6.

    PubMed  CAS  Google Scholar 

  35. Lipscomb L. Overview of the behaviors and experiences of mothers in Georgia, Georgia PRAMS, 1993–1997. Atlanta: Perinatal Epidemiology Unit, Georgia Division of Public Health; 1998.

  36. Centers for Disease Control and Prevention. PRAMS model surveillance protocol; 2003. Available online at http://www.cdc.gov/reproductivehealth/PRAMS/index.htm.

  37. Ricketts SA, Murray EK, Schwalberg R. Reducing low birthweight by resolving risks: Results from Colorado’s prenatal plus program. Am J Public Health 2005;95:1952–7.

    Article  PubMed  Google Scholar 

  38. Lumley J, Oliver SS, Chamberlain C, Oakley L. Interventions for promoting smoking cessation during pregnancy. Cochrane Database Syst Rev 2004;4:CD01055.

    Google Scholar 

  39. Foster DG, Klaisle CM, Blum M, Bradsberry ME, Brindis CD, Stewart FH. Expanded state-funded family planning services: estimating pregnancies averted by the family PACT program in California, 1997–1998. Am J Public Health 2004;94:1341–6.

    Article  PubMed  Google Scholar 

  40. Moos MK. Unintended pregnancies: A call for nursing action. MCN, Am J Matern Child Nurs 2003;28:24–30.

    Article  Google Scholar 

  41. Anonymous. New approach to high-risk pregnancy begins far earlier than traditional programs. Dis Manag Advis 2002;8:149–52.

    Google Scholar 

  42. Gaydos L, Hogue C, Kramer M. Riskier than we thought: revised estimates of women at risk for unintended pregnancy. Public Health Rep 2006;121:155–9.

    Google Scholar 

  43. Mosher W, Martinez GM, Chandra A, Abma JC, Willson SJ. Use of Contraception and Use of Family Planning Services, 1982–2202. Advance Data from Vital and Health Statistics; no 350. National Center for Health Statistics: Hyattsville, Maryland, 2004.

  44. Anonymous. Preventing unintended pregnancy in the U.S. Issues in Brief 2004;3:1–4.

    Google Scholar 

  45. Dietz PM, Adams MM, Kendrick JS, Mathis MP. Completeness of ascertainment of prenatal smoking using birth certificates and confidential questionnaires: Variations by maternal attributes and infant birth weight. PRAMS Working Group. Pregnancy Risk Assessment Monitoring System. Am J Epidemiol 1998;148:1048–54.

    PubMed  CAS  Google Scholar 

  46. Kotelchuck M. Pregnancy Risk Assessment Monitoring System (PRAMS): Possible new roles for a national MCH system. Public Health Rep 2006;121:6–10.

    PubMed  Google Scholar 

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Acknowledgements

The authors are grateful to the Georgia Division of Public Health for providing access to the PRAMS data and the Institute on the Study of Disadvantage and Disability and the Breaking the Cycle project for supporting this research.

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Authors and Affiliations

  1. Department of Epidemiology, Rollins School of Public Health, Women’s and Children’s Center, Emory University, 1518 Clifton Rd NE, Atlanta, GA, 30322, USA

    Sarah A. Collier MPH & Carol J. R. Hogue PhD

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  1. Sarah A. Collier MPH
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  2. Carol J. R. Hogue PhD
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Correspondence to Carol J. R. Hogue PhD.

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Collier, S.A., Hogue, C.J.R. Modifiable Risk Factors for Low Birth Weight and Their Effect on Cerebral Palsy and Mental Retardation. Matern Child Health J 11, 65–71 (2007). https://doi.org/10.1007/s10995-006-0085-z

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