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Low Birth Weight in the Finger Lakes Region: Has There Been Any Improvement?

Low Birth Weight in the Finger Lakes Region: Has There Been Any Improvement?. Chris Glantz, MD, MPH Finger Lakes PDS Advisory Group. Low Birth Weight (LBW). Birth weight <2500 grams 2500g used to be <10 th %tile at term Mostly due to preterm delivery Less commonly due to growth restriction

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Low Birth Weight in the Finger Lakes Region: Has There Been Any Improvement?

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  1. Low Birth Weight in the Finger Lakes Region: Has There Been Any Improvement? Chris Glantz, MD, MPH Finger Lakes PDS Advisory Group

  2. Low Birth Weight (LBW) • Birth weight <2500 grams • 2500g used to be <10th%tile at term • Mostly due to preterm delivery • Less commonly due to growth restriction • Very Low Birth Weight <1500 grams • Highly associated with perinatal morbidity and mortality • Up to 80% of perinatal deaths • BPD, IVH, NEC

  3. VLBW Survival/Morbidity Stevenson et al. AJOG 1998;179:1632

  4. Low Birth Weight Very Low Birth Weight Deliveries by Birth Weight2001

  5. Low Birth Weight Very Low Birth Weight Deliveries by Birth Weight2005

  6. Low Birth Weight Deliveries 2001 Very Low Birth Weight

  7. Very Low Birth Weight Low Birth Weight Deliveries2005

  8. Low Birth Weight: 2001-05 • Low Birth Weight: • Increased from 7.0% to 7.7% • FLR Counties: 4.3% (W) to 8.7% (Y) • USA (2004): 8.1% (up 16% since 1990) • HP2010 Goal: ≤5% • Very Low Birth Weight: • Slight decline from 1.5% to 1.3%

  9. Preterm Delivery Deliveries by Gestational Age2001

  10. Preterm Delivery Deliveries by Gestational Age2005

  11. Preterm Deliveries2001

  12. Preterm Deliveries2005

  13. Preterm Delivery: 2001-05 • Preterm <37 wks: • Increased from 8.8% to 9.5% (babies) • Would be 7.9% to 8.5% for pregnancies • FLR Counties: 6.8% (W) to 13.5% (Y) • USA (2004): 12.5% (up 18% since 1990) • HP2010 Goal: ≤7.6% • Preterm <32wks • Slight decline from 1.7% to 1.4%

  14. LBW and Gestational Age PTD: 9% of all births, but 71% of LBW

  15. LBW by Gestational Age

  16. Small for Gestational Age Birth weight <10th percentile Term or Preterm

  17. Small for Gestational Age Growth Restricted versus Constitutionally Small

  18. SGA- & LBW- SGA- & LBW- SGA+, LBW- SGA-, LBW+ SGA+ & LBW+ SGA+ & LBW+ Preterm Term

  19. LBW and SGA SGA: 10% of all births, but 39% of LBW

  20. Preterm, most LBW is not due to SGA At term, most LBW is due to SGA Prematurity, LBW, and SGA

  21. Multiple Gestation • Incidence increased from 1.7% in 2001 to 2.0% in 2005 • 18% increase • Incidence associated with infertility increased from 0.5% to 0.9% • 80% increase • 95% are twins • No significant change in higher order • 50+% PTD/LBW and 3x increase in IUGR

  22. Multiple Gestation vs Singletons

  23. Multiple Gestation and PTD/LBW • 2% of pregnancies in 2005 were multiples • But accounted for 13% of preterm deliveries • 4% of babies in 2005 were multiples • But accounted for 28% of LBW • Partially account for increased PTD/LBW from 2001 to 2005 • Presumably from assisted reproductive technologies

  24. Lower Threshold for Delivery? Labor Inductions

  25. LBW Demographics

  26. LBW Historical Associations

  27. Antepartum Associations

  28. Nutrition and Smoking • BMI slightly less for LBW/SGA • Only by 1 point on average • Means 25 vs 26 • Weight Gain 5 lbs less for LBW/SGA • Association persists when adjusting for GA • Tobacco is associated with SGA • Weaker association with PTD

  29. Aggregate Associations • Demographic, historical, and antepartum factors predict ≈20% of LBW • PTD & SGA paired predict ≈55% of LBW • PTD more than SGA • Their odds ratios dwarf other factors

  30. Combining Everything • Adding PTD & SGA to regression lowers some other factors’ odds ratios because those factors work through PTD & SGA • e.g., multiples, PIH, previous PTD • Teen, employed, infertility, PNC>3, and male drop off entirely

  31. Conclusions • PTD is the strongest predictor of LBW • No progress in several decades of research • Rate actually worse, but possibly less extreme • SGA is the second strongest predictor • Related to racial, nutritional, medical, and obstetrical factors

  32. Conclusions • Multiple Gestation is a very important predictor • Relation to infertility and assisted reproductive technology • Hypertension is highly associated with LBW • Resistant to improvement over many years of study • Etiology of preeclampsia is unknown • Treating HTN marginally improves perinatal outcome

  33. Conclusions • Decreasing tobacco use may improve low birth weight rates • Tobacco use is higher in NYS than in USA • 20% versus 10% • Nutritional factors are strong predictors • Optimizing pre-pregnancy weight and antenatal weight gain are important • Improving adequacy of PNC may be important for PTD and SGA

  34. The End

  35. Low Birth Weight Very Low Birth Weight Deliveries by Birth Weight2001

  36. Low Birth Weight Very Low Birth Weight Deliveries by Birth Weight2005

  37. Low Birth Weight Deliveries 2001 Very Low Birth Weight

  38. Very Low Birth Weight Low Birth Weight Deliveries2005

  39. Preterm Delivery Deliveries by Gestational Age2001

  40. Preterm Delivery Deliveries by Gestational Age2005

  41. Preterm Deliveries2001

  42. Preterm Deliveries2005

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