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Low Birth Weight Problem in Colorado

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Low Birth Weight Problem in Colorado TIPPING THE SCALES: Weighing in on Solutions to the Low Birth Weight Problem in Colorado AUGUST 2000 Colorado Department of Public Health & Environment • 4300 Cherry Creek Drive South, Denver, Colorado 80246 This report is available in PDF format at http://www.cdphe.state.co.us/fc/lbwreport.pdf Highlights ▼ Colorado has one of the highest low birth weight ▼ Colorado’s singleton low birth weight rate could rates in the nation. In 1997, the state’s low birth be reduced by one-third, and the overall state weight rate was 8.9 percent, with over 5,000 low birth weight rate by one-quarter, if all preg- babies born low birth weight. The Healthy Peo- nant women gained weight adequately and no ple goal for the nation for the year 2000/2010 is pregnant women smoked. If these conditions 5.0 percent. had been met for the 1995–1997 period, the state low birth weight rate would have been ▼ The major contributing factors to low birth reduced from 8.7 percent to 6.4 percent. weight in Colorado (based on 1995–1997 birth certificate data) are multiple births, inadequate ▼ The prevalence of each of the four most impor- maternal weight gain, smoking, and premature tant risk factors can be reduced. rupture of the membranes. • Multiple gestation can be decreased by reduc- ▼ Multiple births are a large contributor to Col- ing the number of multiple gestations result- orado’s low birth weight problem: one out of ing from assisted reproduction; every five low weight births is a multiple. If the • Inadequate weight gain can be reduced by state’s multiple rates could be reduced to a nat- assuring that all women have appropriate urally occurring level (eliminating multiple ges- nutrition counseling and gain an adequate tations resulting from assisted reproduction), amount of weight; there would be a decline of about half a per- centage point in the state’s overall low birth weight • Smoking among pregnant women can be rate (based on 1995–1997 data). reduced by assisting all women to be smoke- free prior to conception or to quit smoking ▼ Inadequate maternal weight gain during preg- early in pregnancy; and nancy is the largest contributor to the number • Premature rupture of of singleton low weight births. If this problem the membranes can were completely eliminated, the low birth weight be reduced by ensur- rate for singleton births would be reduced by ing that all women 12.8 percent, from 7.1 percent to 6.2 percent, a at risk for lower geni- decline of nearly one percentage point. tal tract infections are ▼ Smoking among pregnant women is a signifi- screened and treated early cant contributor to Colorado’s low birth weight in pregnancy, and by increas- problem. If all pregnant women were nonsmokers ing client awareness of or quit smoking during pregnancy, Colorado’s signs and symptoms of singleton low birth weight rate would be reduced preterm labor. by 11.9 percent, resulting in a drop from 7.1 per- cent to 6.3 percent. ▼ Premature rupture of the membranes is another significant contributor to Colorado’s low birth weight problem. If this problem could be elim- inated, the low birth weight rate for singleton births would be reduced by 9.1 percent, from 7.1 percent to 6.5 percent. |||||||||||||||||||||||||||||||||| TIPPING THE SCALES ||||||| Executive Summary olorado has one of the highest low birth nated, and multiple births were no more likely than weight rates in the nation. Low birth weight singleton births to be low weight, the state’s low birth Cis a significant health problem that con- weight rate would be reduced by 19.9 percent, from tributes to infant mortality and to developmental 8.7 percent in 1995–1997, to 7.1 percent. However, and neurological disability. In 1997, the state’s low if the state’s multiple rate could be reduced to a nat- birth weight rate was 8.9 percent, with over 5,000 urally occurring level, eliminating just the multiple babies born low birth weight (5 pounds, 8 ounces gestations resulting from assisted reproduction, with- or less, or less than 2,500 grams). The Healthy Peo- out a change in the low birth weight rate among twins ple goal for the nation for the year 2000/2010 is and higher order multiples, there would be a decline 5.0 percent. of about half a percentage point in the state’s overall low birth weight rate. In 1998, the Colorado Department of Public Health and Environment conducted a multiple regression Among singleton births, inadequate weight gain analysis of low weight births in an attempt to fur- during pregnancy is the largest contributor to low ther quantify the problem of low birth weight. Eigh- birth weight in Colorado. If all pregnant women teen factors captured on the birth certificate were gained weight adequately, the low birth weight rate determined to be closely associated with low birth for singleton births would be reduced by 12.8 per- weight. The most important factors included pre- cent, from 7.1 percent to 6.2 percent, a decline of mature rupture of the membranes, poor maternal nearly one percentage point. weight gain, pregnancy-associated hypertension Smoking among pregnant women is another sig- and/or eclampsia, maternal smoking, abruptio pla- nificant contributor to Colorado’s low birth weight centa, previous preterm or small for gestational age problem. If all pregnant women did not smoke or birth, hydramnios/oligohydramnios, and black race. quit smoking early in pregnancy, Colorado’s sin- In 1999 the Department conducted a follow-up gleton low birth weight rate would be reduced by study to determine which of these factors were asso- 11.9 percent, resulting in a decline from 7.1 per- ciated with the greatest number of low weight births. cent to 6.3 percent. Population attributable risks were calculated to address this question. Inadequate weight gain during pregnancy and smok- ing are together the two most important factors in Population attributable risk is a statistical measure low birth weight among singleton births. Since the that combines the prevalence of a condition in a two factors have an effect on each other, the popu- population (e.g., what percent of women smoke) lation attributable risk for inadequate weight gain with the severity of that condition (smoking dou- and smoking is greater than the effect of each con- bles the risk of low birth weight) to yield a per- sidered separately. Colorado’s low birth weight rate centage of the total (low birth weight) rate which among singleton births could be reduced by one- is “attributable” to the condition in that popula- third, from 7.1 percent to 4.7 percent, if pregnant tion. Four factors were found to have high popula- women who smoked were able to stop smoking and tion attributable risks: multiple births, inadequate if women who gained too little were able to gain maternal weight gain during pregnancy, smoking weight adequately. The overall state low birth weight during pregnancy, and premature rupture of the rate (including multiple gestations) could be reduced membranes. by one-quarter, from 8.7 percent to 6.4 percent, if Multiple births are a large contributor to Colorado’s all pregnant women gained weight adequately and low birth weight problem, accounting for one out of did not smoke. every five low weight births. If the causes of low birth By reducing the occurrence of other treatable fac- weight among multiple gestations could be elimi- tors, the state’s low birth weight rate could be COLORADO DEPARTMENT OF PUBLIC HEALTH & ENVIRONMENT |||||||| i decreased even more. Nearly one-half (47 percent) From the standpoint of prevention, efforts during of the rate could be eliminated by ensuring ade- the preconception period should focus on promot- quate weight gain, eliminating smoking, beginning ing access to and consistent use of contraception, prenatal care in the first trimester, and lengthening screening and counseling women to assist in reduc- the interpregnancy interval among parous women. ing modifiable risk factors for low birth weight, and If this could be accomplished, over 2,000 low weight educating consumers in general about the risks for singleton births could be averted, decreasing the and consequences of low weight births. Behavioral singleton low birth weight rate from 7.1 percent to and lifestyle counseling should also be incorporated 3.8 percent. In addition, if multiple births were into the content of prenatal care. reduced to a naturally occurring level (eliminating Statewide commitment to these strategies, supported those resulting from assisted reproduction), the over- by all stakeholders, can result in a decrease in the all state rate could be reduced to 5.1 percent. Such low birth weight rate in Colorado to a level close to declines would enable Colorado to come close to the Healthy People goal of 5.0 percent. meeting the Healthy People 2000/2010 goal for low birth weight of 5.0 percent. If the occurrence of pre- mature rupture of the membranes (PROM) could ACKNOWLEDGEMENTS This report was prepared by the Family and Community be decreased or eliminated, the state rate could drop Health Services Division along with Health Statistics and even further. Vital Records in the Center for Health and Environmental The analysis of low birth weight in this report focuses Information and Statistics, Colorado Department of Pub- lic Health and Environment. Copies of the report can be on those factors with high population attributable obtained by calling the Women’s Health Section, Family and risks that are also seen as amenable to modification Community Healthy Services Division, at (303) 692-2480. or treatment. Some of these factors are more behav- Principal authors ioral in nature and therefore, less likely to be altered Sue Ricketts, Ph.D., Demographer, Family and by traditional medical interventions.
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