EFFORTS TO REDUCE LOW-BIRTH-WEIGHT AND PRETERM BIRTHS - A STATEWIDE ANALYSIS (VIRGINIA)

OBJECTIVE: The purpose of this study was to ascertain the influence of evolving obstetric and public health care on the occurrence of low bi rth weight and preterm birth in a large population. STUDY DESIGN: Birt h statistics of 2,049,970 live births (25.1% nonwhite) and 156,009 low -birth-weight infants (39.8% nonwhite) were analyzed. RESULTS: Between 1967 to 1971 and 1977 to 1981 the incidence of infants weighing less than or equal to 2500 gm declined from 85.5 to 74.4 per 1000 live birt hs. The percentage of 500 to 1500 gm infants delivered at perinatal ce nters in Virginia increased from 41.8% in 1977 to 1981 to 64.9% in 198 7 to 1991. In spite of regionalization, expanded maternity services, a nd increased use of tocolytic agents the incidence of low-birth-weight infants per 1000 live births in both white and nonwhite populations h as remained comparatively stable since 1976, although the percentage o f term infants weighing less than or equal to 2500 gm has decreased. T he incidence per 1000 live births of infants weighing 500 to 1500 gm h as not changed statistically in 25 years (Student t test). CONCLUSION: The data challenge the overall effectiveness of current programs, inc luding the use of tocolytic agents, and indicate a need to restructure efforts to reduce low birth weight and preterm births.