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Cited by 82Maternal and Neonatal HealthcareInfant Development and Preterm CareGlobal Maternal and Child Health

Low‐Birthweight Prevention Programs: The Enigma of Failure

Stevens‐Simon, Catherine, Orleans, Miriam·1999·Birth
DOI 10.1046/j.1523-536x.1999.00184.x
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Abstract

Background: Low birthweight is the primary cause of neonatal morbidity and mortality in the United States. The purpose of our study was to identify factors associated with the effectiveness and apparent ineffectiveness of comprehensive, multicomponent, prenatal care programs for preventing low birthweight. Methods: We reviewed obstetric, pediatric, and public health program evaluations, research reports, and commentaries, published in the English language literature, over the last four decades that pertained to the efficacy of prenatal care for preventing low birthweight. Results: The heterogeneous nature of the services delivered and the lack of consistency in the definition of variables made it impossible to use rigorous, quantitative techniques to summarize this evaluation of the literature. Two general limitations of research design that emerged from our reviews were the focus on clusters of commonly associated risk factors, which has blurred the causal pathways linking specific risk factors to low birthweight, and the failure to examine process variables. These two methodologic problems have led investigators to erroneous conclusions that overstate the significance of negative intervention outcomes. The success and failure of low‐birthweight prevention programs has rarely been examined in relation to evidence that the intervention actually modified the targeted risk factors. Conclusions: Few rigorous evaluations of well‐designed programs have been conducted. Without an improvement in intervention designs and evaluation studies, recommendations to support or curtail the funding of comprehensive, multicomponent prenatal care services are inappropriate. Rigorously obtained evidence of the costs and benefits of approaches to the prevention of low birthweight are sorely needed.

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Authors
Stevens‐Simon, C., & Orleans, M.
Affiliations
University of Colorado Health (US)
Venue
Birth
Publisher
Wiley
Published
1999-09
Volume
26
Issue
3
Pages
184-191
ISSN
  • 0730-7659 (ISSN-L)
  • 1523-536X
DOI
10.1046/j.1523-536x.1999.00184.x
OpenAlex
W2113567737
Cited by
82
References
82
Citations by year
2022: 1 · 2020: 2 · 2019: 2 · 2018: 4 · 2017: 3 · 2016: 5 · 2015: 5 · 2014: 5 · 2013: 2 · 2012: 2
FWCI
1.51
Type
journal article
Language
en
Open access
closed
Licence
onlinelibrary.wiley.com/termsAndConditions#vor (vor, 845 d)
Locations
  • Birth (publishedVersion)
  • PubMed (publishedVersion)
Topics
  • Health Sciences › Health Professions › General Health Professions › Maternal and Neonatal Healthcare
  • Health Sciences › Medicine › Pediatrics, Perinatology and Child Health › Infant Development and Preterm Care
  • Health Sciences › Medicine › Pediatrics, Perinatology and Child Health › Global Maternal and Child Health
Keywords
low birth weight, prenatal care program, program effectiveness, risk factors, neonatal morbidity and mortality, program evaluation, intervention design, causal pathways, process parameters, multicomponent intervention
MeSH terms
Comprehensive Health Care, Female, Fetal Growth Retardation, Humans, Infant, Low Birth Weight, Infant, Newborn, Obstetric Labor, Premature, Outcome and Process Assessment, Health Care, Pregnancy, Prenatal Care, Primary Prevention, Risk Factors, Program Evaluation

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