Low birth weight in the United States
Low birth weight in the United States
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DOI：
10.1093/ajcn/85.2.584s
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发表时间：
2007-02-01
影响因子：
7.1
通讯作者：
Culhane, Jennifer F.
中科院分区：
文献类型：
--
作者：
Goldenberg, Robert L.;Culhane, Jennifer F.
美国和其他发达国家的妊娠结局比许多发展中国家的妊娠结局好得多。然而，不良妊娠结局在美国通常比其他发达国家更常见。早产后出生或继发于宫内生长受限的低出生体重儿是发病率、死亡率和成本增加的主要原因。不同人口群体在早产和生长受限方面存在很大差异。例如，贫穷和黑人妇女的早产率是其他大多数妇女的两倍，生长受限的比率也更高。一般认为，出生体重低会使婴儿在成年后患糖尿病、高血压和心脏病等慢性疾病的风险更大。有趣的是，母亲的瘦弱是早产和胎儿生长受限的一个强有力的预测因素。然而，在美国，一些营养干预措施，包括高蛋白饮食，热量补充，钙和铁补充，以及各种其他维生素和矿物质补充，一般都没有减少早产或生长受限。细菌性宫内感染在早期早产的病因学中起着重要作用，但至少到目前为止，在分娩前对细菌性阴道病等危险因素进行抗生素治疗或在早产期间进行抗生素治疗并不能持续降低早产率。大多数干预措施未能减少早产或生长受限。在过去的几十年里，美国新生儿存活率的大幅提高主要是由于低出生体重儿更好地获得了更好的新生儿护理。
Pregnancy outcomes in the United States and other developed countries are considerably better than those in many developing countries. However, adverse pregnancy outcomes are generally more common in the United States than in other developed countries. Low-birth-weight infants, born after a preterm birth or secondary to intrauterine growth restriction, account for much of the increased morbidity, mortality, and cost. Wide disparities exist in both preterm birth and growth restriction among different population groups. Poor and black women, for example, have twice the preterm birth rate and higher rates of growth restriction than do most other women. Low birth weight in general is thought to place the infant at greater risk of later adult chronic medical conditions, such as diabetes, hypertension, and heart disease. Of interest, maternal thinness is a strong predictor of both preterm birth and fetal growth restriction. However, in the United States, several nutritional interventions, including high-protein diets, caloric supplementation, calcium and iron supplementation, and various other vitamin and mineral supplementations, have not generally reduced preterm birth or growth restriction. Bacterial intrauterine infections play an important role in the etiology of the earliest preterm births, but, at least to date, antibiotic treatment either before labor for risk factors such as bacterial vaginosis or during preterm labor have not consistently reduced the preterm birth rate. Most interventions have failed to reduce preterm birth or growth restriction. The substantial improvement in newborn survival in the United States over the past several decades is mostly due to better access to improved neonatal care for low-birth-weight infants.