Health Consequences

Low birthweight, due to either preterm delivery or IUGR, is associated with increased neonatal mortality. Mortality tends to increase with decreasing gestational age at delivery and birth weight (Figures 1 and 2). Preterm delivery is the most important obstetric complication in developed

Probability of Mortality

Probability of Mortality

Neonatal Mortality Gestational Age

Gestational Age (weeks) —•— Predicted —i— Actual

Figure 1 Probability of neonatal mortality as a function of gestational age at delivery in 3386 births between 20 and 37 weeks. The predicted mortality curve is smoothed using statistical methods. Reproduced with permission from Copper RL et al. (1993) A multicentre study of preterm birth weight and gestational age-specific neonatal mortality. American Journal of Obstetrics and Gynecology 168: 78-84.

Gestational Age (weeks) —•— Predicted —i— Actual

Figure 1 Probability of neonatal mortality as a function of gestational age at delivery in 3386 births between 20 and 37 weeks. The predicted mortality curve is smoothed using statistical methods. Reproduced with permission from Copper RL et al. (1993) A multicentre study of preterm birth weight and gestational age-specific neonatal mortality. American Journal of Obstetrics and Gynecology 168: 78-84.

Probability of Mortality

Probability of Mortality

Birthweight (grams) —•— Predicted —i— Actual

Figure 2 Probability of neonatal mortality as a function of birthweight in 3386 births between 20 and 37weeks. The predicted mortality curve is smoothed using statistical methods. Reproduced with permission from Copper RL et al. (1993) A multicentre study of preterm birth weight and gestational age-specific neonatal mortality. American Journal of Obstetrics and Gynecology 168: 78-84.

Birthweight (grams) —•— Predicted —i— Actual

Figure 2 Probability of neonatal mortality as a function of birthweight in 3386 births between 20 and 37weeks. The predicted mortality curve is smoothed using statistical methods. Reproduced with permission from Copper RL et al. (1993) A multicentre study of preterm birth weight and gestational age-specific neonatal mortality. American Journal of Obstetrics and Gynecology 168: 78-84.

countries and, together with IUGR, a major cause of neonatal deaths both in developed and in developing countries. However, the burden of disease of preterm delivery and IUGR in terms of neonatal death is disproportionally heavier for developing countries. Ninety-eight percent of neonatal deaths occur in developing countries, and they account for 33% of all deaths of children younger than 5 years of age. Importantly, 50% of all neonatal deaths are due to being born underweight.

Morbidity is also increased in low birthweight newborns and the negative effects of preterm delivery and/or IUGR tend to persist in infancy as deficits in growth and neurological development. In addition, there is evidence that the negative effects of IUGR may persist long after infancy because low birthweight has been associated with the development of cardiovascular disease, high blood pressure, obstructive lung disease, diabetes, high cholesterol concentrations, and renal damage in adulthood.

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