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Background Low birthweight (LBW) as well as early childhood stunting are risk factors for increased childhood morbidity in low-and middle-income countries (LMIC). The Covid 19 pandemic has exacerbated food insecurity and unemployment globally, prompting concerns for maternal and child health. Objectives We used data from the great recession of 2008 to examine the relationship between household food security and other risk factors with LBW and stunting using a longitudinal sample of South African women and their offspring. Methods Food security indicators, alcohol use, blood pressure and other characteristics were examined in relation to LBW ([less than or equal to] 2500 g), stunting (height for age [less than or equal to] 2SD) and severe stunting (height for age [less than or equal to] 3SD). Regression modelling with clustering at maternal ID level were employed to adjust for maternal characteristics and women who gave birth more than once during the reference period. Results Birthweight data were available for 1173 children and height for age 1216 children. The prevalence of LBW was 14.7% while stunting and severe stunting was 17.8% and 14.5%. Child hunger in the household, maternal hypertension and alcohol use were associated with low birthweight. Food expenditure below the Stats SA poverty line and low dietary diversity was associated with stunting and severe stunting respectively. Maternal height and low birthweight were associated with both stunting and severe stunting. Conclusions for Practice Interventions that can improve household food security and nutritional status during the periconceptional and antenatal period may reduce the prevalence of low birthweight and subsequent stunting in low- and middle-income countries., Author(s): Abigail Harper [sup.1] , Alan Rothberg [sup.2] , Esnat Chirwa [sup.3] , Winnie Sambu [sup.4] , Sumaya Mall [sup.1] Author Affiliations: (1) grid.11951.3d, 0000 0004 1937 1135, Department of [...]

The large costs imposed by the low birth weight (LBW) infants on the society are discussed.

Individual-level maternal risk factors have been able to explain only a small proportion of low birth weight (LBW) births in the US to date and neighborhood-level factors have not been recognized as important predictors of reproductive outcomes. At the US/Mexico border, tremendous demographic changes have taken place between 1980 and 1990. Whether high population growth, economic pressures, and community instability have affected reproductive health in this region is not known. We used spatial epidemiologic methods to investigate the importance of changes in neighborhood and individual-level risk factors in predicting changes in two measures of adverse reproductive health: term and preterm LBW. Using approximately 16,000 births in 1980 and 24,000 births in 1990, we produced a continuous surface of LBW change (Z scores for difference in proportions) for southern San Diego County, CA, and identified statistically significant 'hot spots' of elevated risk. Using a geographic information system, data from the 1980 and 1990 US Census were smoothed to link neighborhood-level variables with individual-level data from the 1980 and 1990 California birth certificates. Multivariate regression models were developed to identify individual- and neighborhood-level variables of 1980-1990 changes which were predictive of Z scores of LBW change. Results of conditional autoregressive models were used to assess effects of spatial autocorrelation. The continuous surface of LBW identified areas with statistically significant increases (17) areas for term LBW and 14 areas for preterm LBW). While individual- and neighborhood-level variables explained about an equal amount of variance in term LBW, only neighborhood-level variables were significant predictors of preterm LBW. While changes in maternal race/ethnicity composition and a measure of stability were related to term LBW, measures of affluence were related to preterm LBW. This study highlights the importance of socioeconomic and demographic changes in a woman's neighborhood on reproductive health. Keywords: Low birth weight; Spatial methods; Epidemiology; Reproductive health; San Diego county; Neighborhood level factors; USA

A study was conducted to analyze the relationship between socioeconomic status and low birth weight. The interactive effects of socioeconomic status and low birth weight were examined. Data from the British National Child Development Survey were utilized to carry out the analysis. Results indicated that high socioeconomic status mitigate the effects of low birth weight on female health status.

Prenatal care which improves birth weights not only increases the child's chances for survival and good health, but could result in significant savings in the cost of health services. An analysis was made of all very low birth weight (VLBW) live births in California in 1986 and 1987 that were eleigible for Medicaid. Average treatment costs for a birth below 1500 grams was $93,800 for the first year. A birth below 750 grams cost #273,900. Prenatal care which results in a normal birth rather than VLBW saves an average of $59,700 in first year expenses., Objective. Very low birth weight (VLBW) infants (those with birth weights [is less than] 1500 g) account for only 1.2% of births but 46% of infant deaths. Large improvements in neonatal technology in the last 2 decades have significantly improved survival prospects for infants with low birth weights, but at a high cost. Due largely to a lack of data, the costs of medical care during the period in which infant mortality is measured (the first year of life), as well as the cost-effectiveness of that care for VLBW infants, have not been quantified. Despite this fact, public policies both toward providing insurance coverage for their care, as well as denying payment for their treatment, have either been proposed or implemented on cost-effectiveness grounds. Patients. The study includes all VLBW single live births in the state of California during 1986 and 1987 that were continuously eligible (through traditional channels) for the state's Medicaid program. Main Outcome Measures. Treatment costs were measured for all medical care received during the first year of life, including all inpatient and outpatient care received. The cost-effectiveness of care is measured by aggregate treatment costs for all singleton VLBW liveborns divided by the number of first-year survivors. Results. Average treatment costs per first-year survivor for infants [is less than] 1500 g was $93 800 (in 1987 constant dollars). Treatment costs per survivor were twice as high for infants [is less than] 750 g ($273 900) as for the next highest birth weight group 750 to 999 g ($138 800) which was itself almost twice as high as for the 1000 to 1249 g group ($75 100). The gradient in cost-effectiveness with birth weight then drops off to $58 000 per survivor for infants with birth weights between 1250 and 1499 g. Conclusion. Public policies aimed at improving birth outcomes by providing insurance coverage for pregnant women and children, such as the recent Medicaid expansions, can potentially be very cost-effective. Although maternal interventions such as prenatal care are relatively inexpensive, each normal birth that results instead in a VLBW birth saves $59 700 in first year medical expenses. However, cost savings attributable to increased birth weights depend on where in the birth weight distribution the increase occurs as well as the size of the birth weight increase. For infants with birth weights [is greater than] 750 g, significant gains can accrue from even a small shift in the birth weight distribution. A shift of 250 g at birth saves an average of $12 000 to $16 000 in first year medical costs and a shift of 500 g generates $28 000 in savings. However, there is a threshold effect on birth weight. For infants [is less than] 750 g, increases in birth weight may increase medical expenditures. For instance, a shift in birth weight to the 750 to 999 g range increases costs by $29 000. Pediatrics 1998;102:35-43; cost-effectiveness, cost, very low birth weight infants. ABBREVIATIONS. VLBW, very low birth weight; CPI, consumer price index., Very low birth weight (VLBW) infants (those with birth weights [is less than] 1500 g) are a high-risk patient population. Although they account for only 1.2% of births, these infants [...]

The establishment of minimum birth weights, below which medical care would be withheld, may not produce significant cost-savings in neonatal intensive care. Very-low-birth weight (VLBW) babies have very high rates of medical and developmental conditions and early death, and the cost of caring for them can be very high. Researchers evaluated the outcome of intensive care for 1,361 VLBW babies. The average costs of care for babies who survived varied from $74,101 to $250,654, depending on weight at birth. Substantial cost savings would require denial of care to infants likely to survive., Objective. Neonatal intensive care for very low birth weight (VLBW) infants is expensive, and cost-containment policies have been proposed that would restrict care according to birth weight. We examined the potential reduction in neonatal intensive care unit (NICU) VLBW charges and the impact on survivors if care were not offered to infants of extremely low birth weights or gestational ages. Design. We reviewed hospital charges for a retrospective cohort of VLBW infants born during the 5-year period from 1988 to 1992. Local charges and survival statistics were applied to national VLBW birth statistics to estimate the national effects of a birth weight-based rationing program. Setting. A high-risk perinatal referral center. Patients. A consecutive sample of 1361 VLBW infants was tracked from birth to discharge home, transfer to a level II nursery, or death. Main Outcome Measures. Hospital charges and survival. Results. Mean charges per survivor ranged from $250 654 for infants weighing [is less than] 500 g to $74 101 for those weighing 1000 to 1500 g. Policies denying care to infants born at [is less than] 500, 600, or 700 g would lead to total NICU care savings of 0.8%, 3.2%, and 10.3%, respectively. Applying the local birth weight-specific survival rates, such policies applied nationally would not have offered care to 136, 575, and 2689 potential survivors annually. Birth weight-based rationing schemes also are shown to increase further the racial disparity of NICU deaths. Conclusions. To attain significant reduction in NICU charges, policies offering care to the larger or more mature VLBW infants only will result in denying care to many infants who would otherwise survive. Pediatrics 1998;101:344-348; very low birth weight infants, neonatal intensive care, health care rationing., Neonatal mortality in the United States has fallen dramatically during the past 3 decades. Prematurity and its sequelae, the major causes of neonatal mortality, now are managed as matters of [...]

Families of babies with low birth weight and gestational age, which often result from multiple pregnancies, tend to incur higher hospital inpatient costs. About 50% of the increase in overall hospital costs associated with multiple pregnancy is being attributed to lower gestational age. Expenses related to babies with low birth weight, meanwhile, constitute 40% of the increase in overall hospital costs related to multiple gestation.

Women with low birthweight infants or complicated pregnancies face unexpected and serious expenses as well as a need for longer leave than that allocated in the Family and Medical Leave Act. Twenty-seven percent of mothers of low birthweight infants returned to work after their child's birth compared to over 80% of mothers of term infants. Most families, regardless of their income level incurred nonreimbursable expenses of over one percent of their yearly income. For families of low birthweight infants modern leave policies are still insufficient.

If only 1% of pregnant women who smoke would quit smoking, it would prevent 1,300 low-birth-weight babies from being born and save $21 million in direct medical costs in the first year alone. This was the conclusion of researchers who analyzed the medical costs of low birth weight caused by smoking. The total cost to treat low birth weight caused by smoking was $263 million., Objectives. To estimate excess direct medical costs of low birth weight from maternal smoking and short-term cost savings from smoking cessation programs before or during the first trimester of pregnancy. Methods. Simulations using data on neonatal costs per live birth. Outcome measures are mean US excess direct medical cost per live birth, total excess direct medical cost, reductions in low birth weight, and savings in medical costs from an annual 1 percentage point drop in smoking prevalence among pregnant women. Results. Mean average excess direct medical cost per live birth for each pregnant smoker (in 1995 dollars) was $511; total cost was $263 million. An annual drop of 1 percentage point in smoking prevalence would prevent 1300 low birth weight live births and save $21 million in direct medical costs in the first year of the program; it would prevent 57 200 low birth weight infants and save $572 million in direct medical costs in 7 years. Conclusions. Smoking cessation before the end of the first trimester produces significant cost savings from the prevention of low birth weight. Pediatrics 1999;104:1312-1320; tobacco, pregnancy, economics, smoking cessation., ABBREVIATIONS. LBW, low birth weight; NICU, neonatal intensive care unit; IUGR, intrauterine growth retardation; RR, relative risk; VLBW, very low birth weight; MLBW, moderately low birth weight; PAR, population attributable [...]