Michael O. Schroeder
U.S. News & World Report
Expectant parents can take steps to tip the scales in favor of a newborn’s long-term health.
While improvements in medical technology are making it possible for smaller babies to survive, new research finds that low birth weight raises a child’s risk of death not just at birth, but later in life as well.
A study published in May in the journal PLOS Medicine shows that low birth weight – when a child is born under 5 pounds, 8 ounces – raises mortality risk due to causes ranging from infections and respiratory conditions like pneumonia to congenital heart defects. The effect is even more pronounced for very low birth weight babies, who are born weighing less than 3 pounds, 5 ounces. “Our study confirms what has already been known for many years: that babies born with low birth weight have increased risk of dying in the first year of life. However, the study also showed that there is continuing risk of dying in childhood and adolescence for babies born with low birth weight,” lead researcher Dr. Sailesh Kotecha, head of child health at Cardiff University’s School of Medicine in Cardiff, Wales, said in an email.
What’s more, says Dr. Matthew Loichinger, perinatalogist at The Mother Baby Center at Abbott Northwestern and Children's Minnesota in Minneapolis: “There’s studies that show that babies that are born at low birth weight may be at risk for certain health consequences later in life like high blood pressure, coronary artery disease, chronic kidney disease, obesity and metabolic syndrome.” It’s theorized that low birth weight may play a role in the development of these conditions, though Loichinger stresses that other studies haven’t found that relationship.
[See: How to Cope With Gestational Diabetes.]
It’s unknown why many babies are born at low birth weight. Though genetics can play a part, modifiable risk factors ranging from smoking to poor maternal health can contribute.
“The most important thing is that moms are as healthy as possible before becoming pregnant,” says Dr. Paul Jarris, senior vice president for maternal child health and deputy medical director at the March of Dimes, which seeks to prevent birth defects, premature birth and infant mortality. Unfortunately, with about half of all pregnancies being unplanned in the U.S., he says there’s often a missed opportunity to ensure that happens. Planning for pregnancy allows a woman to see her primary care doctor or OB-GYN before a child is conceived for routine checkups and to address concerns before becoming pregnant. That includes getting any chronic health conditions under control, ranging from blood pressure to diabetes, since these can increase the likelihood of having a preterm delivery or low birth weight baby.
This also affords the opportunity – which may be missed with a pregnancy that's not expected – to begin prenatal doctor visits early in the pregnancy, as advised, when critical development is taking place, says Dr. Jennifer Risinger, an OB-GYN and physician executive for Palmetto Health Baptist Parkridge, a hospital in Irmo, South Carolina.
Thankfully, pregnancies and babies are resilient, Risinger says. But that doesn’t mean simply taking in extra calories is a substitute for eating well and maintaining a healthy, active lifestyle. Though research is mixed, there seems to at least be an indirect link between obesity and low birth weight babies, since the added pounds can raise the risk of certain medical conditions like diabetes and affect overall maternal health. “Often overweight women have poor nutritional status,” Risinger says.
In addition to low birth weight babies being born to overweight patients and women who smoke, Risinger also sees low birth weight infants being born to women who have underlying high blood pressure as well as some older moms. “A lot of women are putting off childbearing until they’re done with school, and their career is going, and so you already have some underlying heart disease,” she says. That can affect blood flow in the uterus and placenta that’s important for a baby’s growth and development. Jarris notes the youngest and oldest moms – those under 17 and over 35 – are more likely to have low birth weight babies.
[See: 10 Things No One Tells You About Breast-feeding.]
Jarris also emphasizes the importance of spacing pregnancies to be at least 18 months apart. When pregnancies occur closer together, particularly where they're less than six months apart, the rates of preterm birth, stillbirth and other issues increase, he says.
Some deeply rooted societal factors, like poverty, are also associated with increased rates of low birth weight. But even such entrenched circumstances can be somewhat counteracted by a strong support structure, experts say, from family to comprehensive group visits, or so-called centering programs. Coordinated by health providers, these group visits that supplement individualized care allow expectant parents to come together with peers for advice and education. Studies show women who have been through a centering program in pregnancy have much better pregnancy outcomes. That includes lower rates of babies being born at a low birth weight, fewer admissions to newborn intensive care units and fewer preterm deliveries, Risinger says, in addition to more moms choosing to breast-feed.
For couples who struggle to get pregnant and who opt for assistive reproductive technology, like in vitro fertilization, Jarris advises checking out providers and their rates of multiple births. While some couples may find having twins to be desirable, a multiple pregnancy (having twins, triplets or more) carries a higher risk for premature birth and low birth weight. By law, assistive reproductive technology facilities must report statistics that include success rates, number of singleton pregnancies – one child on the way – and multiple pregnancies to the Centers for Disease Control and Prevention; this information is searchable online by entering a ZIP code and looking at specific facilities.
“What we would like to see in this country is a greater use of single embryo transplants,” Jarris says. Though some parents and doctors advocate for implanting multiple embryos, if done right, implanting one embryo offers reasonably a good chance of a pregnancy, Jarris says – and lower rates of low birth weight and preterm birth. However, for unknown reasons, he says undergoing any such fertility treatment – even if it results in a singleton pregnancy – increases the chances of preterm birth.
Jarris separately suggests that any expectant mom who’s had a prior singleton pregnancy resulting in a preterm birth talk with her doctor about receiving weekly injections of a medication called 17 hydroxyprojesterone, or 17P, which is typically initiated between 16 and 20 weeks. “This dramatically reduces preterm birth as well as delaying birth,” he says. The drugs are typically well-tolerated, though common side effects include pain and swelling at the injection site, nausea and diarrhea, he adds.
[See: In Vitro Fertilization Grows Up.]
Based on the latest research, Kotecha reiterates what happens before a child is born – and how that affects the baby’s size when he or she arrives – can have long-term implications. As a result, simply trying to play catch-up with weight after birth, experts say, is a losing strategy. “We should make all efforts to prevent … low birth weight in the first place,” Kotecha says.
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