THE ROLE OF PRENATAL-CARE IN PREVENTING LOW-BIRTH-WEIGHT

Prenatal care has long been endorsed as a means to identify mothers at risk of delivering a preterm or growth-retarded infant and to provide an array of available medical, nutritional, and educational intervent ions intended to reduce the determinants and incidence of low birth we ight and other adverse pregnancy conditions and outcomes. Although the general notion that prenatal care is of value to both mother and chil d became widely accepted in this century, the empirical evidence suppo rting the association between prenatal care and reduced rates of low b irth weight emerged slowly and has been equivocal. Much of the controv ersy over the effectiveness of prenatal care in preventing low birth w eight stems from difficulties in defining what constitutes prenatal ca re and adequate prenatal care use. While the collective evidence regar ding the efficacy of prenatal care to prevent low birch weight continu es to be mixed, the literature indicates that the most likely known ta rgets for prenatal interventions to prevent low birth weight rates are (1) psychosocial (aimed at smoking); (2) nutritional (aimed at low pr epregnancy weight and inadequate weight gain); and (3) medical (aimed at general morbidity). System level approaches to impact the accessibi lity and the appropriateness of prenatal health care services to entir e groups of women and populationwide health promotion, social service, and case management approaches may also offer potential benefits. How ever, data on the effectiveness of these services are lacking, and whe ther interventions focused on building cohesive, functional communitie s can do as much or more to improve low birth weight rates as individu alized treatments has yet to be explored. The ultimate success of pren atal care in substantially reducing current low birth weight percentag es in the United States may hinge on the development of a much broader and more unified conception of prenatal care than currently prevails. Recommendations for actions to maximize the impact of prenatal care o n reducing low birth weight are proposed both for the public and for t he biomedical, public health, and research communities.