Advisory Committee on Infant Mortality LOW BIRTH WEIGHT REPORT AND RECOMMENDA TlONS final Report to Secretary of the U.S. Department of Health and Human Services December, 2001 The views expressed in this docwnent are solely those of the Advisory Committee on Infant Mortality and do not necessarily represent the views of the Health Resources and Services Administration nor the United States Government. Antoinette Parisi Eaton, M.D. Chairperson Peter C. van Dyck. M.D., M.P.H. ACIM Executive Secrttary Kerry P. Nesseier, R.N., M.S. Advisory Committee on Infant Mortality Principal Staff December 2001 Dear Colleague: The Advisory Committee on Infant Mortality (ACrM) was established to "advise the Secretary on Department programs, which are directed at reducing infant mortality and improving the hea1th status ofpregnant women and infants." Since low birth weight (less than 2,500 grams) is a major contributor to infant morbidity and mortality, this issue is ofparticular concern to the Committee, and reduction in the pretenn delivery rate (before 37 weeks gestation) bolds great promise for reduction in the low birth weight rate. In 1999, 11.8 percent ofbirths in the United States were delivered pretenn, with the rate being almost twice as high among blacks compared to whites. Pretenn birth is the second leading cause of neonatal mortality in the United States. Survival rates of infants have been shown to increase as gestational age advances; therefore, an understanding of the causes ofpretenn birth can contnbute significantly to the reduction ofthe infant mortality rate. Rising pretenn delivery rates, as well as the persistent racial and ethnic disparities, were identified by the Committee as requiring immediate attention in order to make progress toward the national Healthy People 2010 goals ofreducing the rate of low birth weight and eliminating disparities in birth outcomes. We are pleased to present AClM's fmal report entitled "Low Birth Weight Report and Recommendations." This document is the culmination ofwork by an ACIM-appointed subcommittee of 12 members who reviewed and synthesized current knowledge on the subject ofpretenn delivery and developed recommendations for further research and action. The ACTh1 subcommittee -- composed of experts in infant mortality, low birth weight, preterm delivery, disparities, and faith-based programs at the national, State, and local levels - met over a 2-yearperiod. invited expert opinion, reviewed the cuneot literature, and sought consensus on its recommendations from the entire Committee. We would like to call your attention to the following recommendations, which are discussed in more detail in the report: 1. Establish a coordinated approach to develop a research strategy by reestablishing the Department ofHealth and Human Services Interagency Working Group on Low Birth Weight; 2. Improve our understanding ofmolecular, genetic, biological, and psychosocial mechanisms of pretenn birth through clinical and psychosocial investigations; 3. Assess the content, quality, organization and fmancing ofthe aspects of service delivery that impact low birth weight and pretenn birth; and 4. Guide program and policy invesnnents that will contribute to healthy families. We believe that the recommendations in this report will serve as a guide for future research and policymaking as we seek to both lower the Nation's infant mortality rate and reduce disparities. Sincerely, Antoinette Parisi Eaton. M.D. Chairperson ACIM Telephone 301/443-2170 Parklawn Building, Room 18-05,5600 Fishers Lane, Rockville, MD 20857 Fax 301 /44 3-1 797 Table of Contents Advisory Committee Members .......................................•............• _..... ..........i Acknowledgements........................................................................._.. .....iii Executive SlUlUTIary........ ... ••... ... ....••. _.....••..........••••.............•• _. ... •••. .••.......1 Low Birth Weight Report and Recommendations 1. Introduction and Overview ............................................ ...........5 ll. Statement ofthe Problem ..................................... .................. .. 6 III. Conclusions........................................................................13 IV. RecoIllIl1endations..........•....................... .•.•. .........................15 List ofRecommendations........ _........ , _........................ ...............................18 References ................. .. ... ............... ........................................... ... ........ 21 Appendix I... .... ... ... ......... ...... .... ........... .................... .......... ............... .. 26 Appendix ll......................................................................... ............. .... 27 ADVISORY COMMITTEE ON INFANT MORTALITY (ACIM) 2001 ADVISORY COMMITTEE MEMBERS Antoinette Parisi Eaton, M.D. Fredric C. Frigoletto, Jr., M.D. '" Chairperson, AC!M Professor ofOB/GYN Professor ofPediatrics, Emerita Harvard Medical School Ohio State University Boston, Massachusetts Columbus, Ohio David E. Gagnon '" Larry Roger Andenon, M.D. '" President Family Practice Physician National Perinatallnformation Center Swnner County Family Care Center, P.A. Providence, Rhode Island Wellington, Kansas Elizabeth H. Hadley, M.P.H., J.D. Polly Arango '" Consultant Past Executive Director Chevy Chase, Maryland Family Voices Algodones, New Mexico Robert E. HannemanD, M.D. *. Visiting Professor ofBiomedical and Bruce B. Bragg, M.P.H. '" Chemical Engineering Director Purdue University Ingham County Health Department West Lafayette, Indiana Lansing, Michigan Agnes Hinton, R.D., M.S., Dr.P.H. James W. CoDins, Jr., M.D., M.P.H. * Associate Professor Associate Professor Center for Community Health Northwestern University Medical School Hattiesburg, Mississippi Chicago, Illinois Bette Rusk Keltner, Ph.D. * Mary Lou de Leon Siantz, Ph.D., R.N., Dean, School ofNursing and Health Studies F.A.A.N. Georgetown University Professor, Associate Dean Washington, D.C. Georgetown University Washington, D.C. Darlene A. Lawrence, M.D. Family Practice Physician Nancy L. Fisher, R.N., M.D., M.P.H. !MAN! Health Care Medical Director Washington, D.C. Regence BlueShield Seattle, Washington i Tracy A. Lieu, M.D., M.P.H. Jesus J. Rubio, Pb.D. Associate Professor Administrator Harvard Pilgrim Health Care & Harvard Associated Catholic Charities Medical School Houston, Texas Boston, Massachusetts Betty K. Tu, M.D., M.B.A. Cbarles S. Mahan, M.D. Clinical Associate Professor Dean, College ofPublic Health Keck School ofMedicine, USC · LAC University ofSouth Florida Anaheim, California Tampa, Florida Kathleen Filip Waleko, Ph.D., M.B.A. Marsha McCabe, M.S. Vice President, Patient Care SeIVices Senior Manager Magee-Wornen's Hospital ofthe University Raytheon Company ofPittsburgh Lexington, Massachusetts Pittsburgh, Pennsylvania Elizabeth R. McAn3roey, M .D. * Deborah Klein Walker, Ed.D. Professor and Chair Associate Conunissioner Children's Hospital at Strong Massachusetts Department ofPublic Health Rochester, New York Boston, Massachusetts Linda A. Randolph, M.D., M.P.H. Kenneth D. Wells, M.D. Research Professor and Chair President Georgetown University Wellcorp Arlington, Virginia Houston, Texas Ann Miller Redmond, Ph.D. * **Co-Chair, Subcommittee on Low Birth Director of Pastoral Care Weight Cook Children's Medical Center Fort Worth, Texas * Member, Subcommittee on Low Birth Weight E. Albert Reece, M.D. The Abraham Roth Professor and Chairman Temple University School ofMedicine Philadelphia, Pennsylvania Carolina Reyes, M.D. *'II Assistant Professor UCLA School ofMedicine Los Angeles, California Diane Rowland, Sc.D. Executive Vice President The Kaiser Family Foundation Washington, D.C. ii ACKNOWLEDGEMENTS The members ofthe Advisory Committee on Infant Mortality wish to acknowledge the efforts of many other people who contributed to the preparation oftrus report. The Advisory Committee appreciates the ongoing contributions and commitment of Robert Goldenberg, M.D., Professor of Obstetrics and Gynecology, University ofAlabama at Binningham; Michael Kogan, Ph.D., Director, Office ofData and Infonnation Management, Maternal and Child Health Bureau (MCHB), Health Resources and Services Administration (HRSA); Stella Yu, ScD., Statistician, MCHB, HRSA; and Renee Scbwalberg, M.P.H., Director, Maternal and Child Health Infonnation Resource Center. iii Advisory Committee 00 Iofant Mortality Low Birth Weight Report and Recommendations December 2001 Executive Summary I. Introduction and Overview The Advisory Committee on Infant Mortality (AClM) was established to "advise the Secretary on Department programs, which are directed at reducing infant mortality and improving the health status ofpregnant women and infants." In 1998, ACIM appointed a subcommittee of 12 members to review and synthesize current knowledge on the subject of pretenn delivery and to develop recommendations for further research and action. The purpose ofthis report is to call to the attention ofthe Secretary the urgency ofthe problem ofpreterrn delivery, one ofthe two major causes of low birthweight, and to encourage an intense and dedicated effort to improve the health ofall mothers and infants. II. Statement of the Problem Pretenn delivery, or delivery before 37 completed weeks ofgestation, represented 11.8 percent ofbirths in the United States in 1999 (Ventura, 200 I). Greater than one half of pretenn births are the result ofpreterm labor and premature rupture ofthe membranes. After congenital anomalies, preterm