REDUCTION OF LBW WITH ENHANCED ANTENATAL CARE

Abstract

A blind trial of enhanced antenatal care was carried out, involving 11,000 pregnancies. The purpose was to decrease (a)LBW, (b)need for antenatal referral and neonatal intensive care, and (c)mental handicap. Group allocation was by stratified randomization using previous LBW scores. Physicians used a risk appraisal system, and referred pregnant women to Community Health Nurses. The program emphasized prenatal class attendance, and home visiting for counselling on nutrition, exercise, food finances, support, coping with stress, smoking and alcohol.

Sub-group analysis excluding a non-compliant area showed a decrease in LBW , a 25% decrease <2000g (16.2vs21.7/1000,α=.043), and a 43% decrease in 1500-1999g (7.4vsl2.9/1000,α=.007) in the compliant enhanced care areas.

In the 25% of smokers still smoking 10+c/d at first home visit the LBW rate was 9.8%, in light smokers 4.0%, in non-smokers 2.8%, 75% of BW variance with study socio-lifestyle factors was attributed to smoking. In heavy smokers only unmarried showed a higher incidence (α=.01) of LBW. Smokers accounted for 60% of LBWs and heavy smoking accounted for 35% excess.

In interviewed non-smokers LBW showed a relation to inadequate nutrition (2.1vs3.8%,α=.03), lack of exercise (2.5vs4.9%,α=.05), and insufficient food finances (2.5vs6.4%,α=.01). Inadequate nutrition at first home visit accounted for 24% excess LBW, lack of exercise 12%, insufficient food finances 8%. Programs to reduce these detrimental factors decrease LBW.

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