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Infant mortality rates have been unacceptably high in the past. Bains reports: “Of the deaths in England in 1859, no less than 184,264 – two in every five of the deaths of the year – were of children under five years of age; and above half of these – 105,629 – had scarcely seen the light, and never saw one return of their birthday”. It was not until antibiotic invention in the 1940’s, mechanical ventilation advent in the 1950’s, and surfactant replacement therapy development in the 1980’s, that survival of premature and low birth weight infants improved. Matsuo (2005) indicates “Whereas few infants with birth weights below 750 g were actively treated before the 1980’s, treatment is now accepted practice for most infants born in North America with birth weights of at least 500 g, those born at 24 or more weeks’ gestation, or both.” This is a large success of medicine in the United States and developed countries in the raised survival of low birth infants over the past three decades. However, the incidence of low birth weight is remarkable.

The Disorder: Low Birth Weight

According to the World Health Organization, low birth weight infant is a baby weighing less than 2,500 grams. Low birth is not a homogenous pregnancy outcome; instead, it comprises infants born prematurely or with intrauterine growth restriction. A preterm infant is one born less than 37 weeks of gestation, regardless of birth weight. Low weight at birth represents a significant problem worldwide.

The Spread of the Disease

In most developed countries, the incidence of low birth weight infants is increasing. In the US, the proportion of low birth weight infants rised from 6.8% in 1980 to 7.4% in 1998. Nevertheless, due to improved medical support, neonatal mortality rates are 4–6 per 1000 newborns in the United States, versus 40 per 1000 newborns in developing countries.

Social Factors

Socioeconomic status of the mother, and her associated lifestyle, plays a crucial role in the probability to deliver a low birth weight infant. Socioeconomic variables are generally those composed of income, education and occupation. Social inequalities may result in low birth weight, however, existing behind the traditional socioeconomic concept. Socio-economic factors, the nature of funding of health care may further contribute to differences in the low birth weight outcomes. Thus, some outcomes that were reported might not correspond to low weight per se but represent social disturbances of the mothers who give bear to small babies. Furthermore, Matsuo concludes, “adverse perinatal conditions resulted in severe educational disabilities, whereas less severe outcomes were influenced by socio-demographic factors”. One may assume that social factors are capable to have a protective effect on behavioral problems.

Social factors of low birth weight are smoking, alcohol, stress, coffee, and socio-demographic risk factors: age, education, marital status, social class (Matsuo, 2005). Matsuo (2005) insists that risk factors for low birth weight are also likely to be determinants mediating the health consequences of low birth weight after birth. Davis et al (2009) indicate low socioeconomic status, chronic stress and perinatal depression are social causes of the analyzed issue. Even though two thirds of reasons to deliver a low weight baby fail to be recognized, the available literature suggests strong correlation between social patterns and the risk to deliver a low birth weight infant. Shah & Ohlsson (2002) report tobacco use, coffee consumption, alcohol and cocaine exposure, passive smoking, occupational hazards, extremes in maternal age (U-shaped tendency), low protein diet, bacterial vaginosis, HIV and urinary tract infection are recognized among them risk factors to deliver a low weight infant. Goldenberg and Culhane add race, poverty and maternal thinness to the risk factors to deliver a small baby.

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For unknown reasons, belonging to various racial and ethnic groups is very strongly associated with both preterm birth and growth restriction. For example, in the US black women are much more likely to give birth to a low weight child than other racial groups.

Many potentially modified risk factors for low birth weight may actually influence individual long-term outcome. Consider smoking, a well-known cause of asthma, alcohol with its evident psychomotor negative impact, fertility treatment (reproductive technologies are associated with low birth weight incidence). Farther, poorer social class is generally associated with smoking. Thus, this is a complex indicator to research. Nevertheless, some truly social variables seem to be credible: higher level of maternal education leads to better pregnancy outcomes, marital status in some countries correlates with premature birth well. Consequently, socio-economic effects interact with each other extensively.

Management

Eight percent of all infant stays included a diagnosis low birth weight account for almost a half of total infant costs. Eight percent of them included diagnosis of preterm/low birth weight but accounted for 47% of infant costs. Of these, low birth weight makes 90% of costs. The mean cost for a preterm/low birth weight infant stay was USD 15,100, compared with USD 600 for an uncomplicated newborn and USD 2,300 for all other infant hospitalizations. The mean length of stay for preterm/low birth weight, uncomplicated, and all other infants were 12.9, 1.9, and 3.0 days, respectively.

Prevention

According to Goldenberg & Culhane, the predictors of low weight at birth are: race and poverty, smoking, physical maternal status, prior low weight birth, biological fluid markers. Thus, the authors claim it is hard to reduce the incidence of low birth weight. However, new achievements in medicine might help – intrauterine bacterial infection prevention strategies, nutritional interventions. Programs for reducing adverse health behaviors and perinatal care patterns are promising.

Conclusion

In conclusion, social maternal factors are significantly associated with low birth weight. Pregnancy with low birth weight is one of the most difficult medical issues to address. Although survival is improving, the proportion of babies born with small weight is growing. The indicated subject is a challenge to the medical society in the twenty-first century.