Tiny babies, big problems

At 4 pounds, Shaayla Hill was a tiny newborn. The fact that she survived can be considered a medical wonder, but by the time she was 3 years old, her health still wasn’t up to par. As a toddler, she was at the doctor more frequently than her sisters, both of whom were born at normal birth weights, says her mom, Lemonia Sims.

“She had pneumonia twice after she was born and she gets sick really easily,” says Sims, who lives in Chicago. There have been some developmental delays as well.

Shaayla is one of a growing number of babies born at less than 5 pounds, 5 ounces—officially dubbed"low birth weight” by the medical profession.

Nationally, more underweight babies are being born now than at any point during the last three decades, according to the Centers for Disease Control and Prevention, although no one seems to know exactly why.

And the rate of low-birth-weight babies in Chicago has remained stubbornly higher than the national average for the past 12 years. Ten percent of Chicago babies were born underweight in 2002, the latest year for which data is available, compared to 7.8 percent nationally. That means 4,783 underweight babies were born locally and more than 300,000 nationwide.

Reasons elusive

Although no one can pinpoint the reason for the increase in low-birth-weight babies, theories abound. Doctors say some low-weight births might be due to stress, while others result from a society that doesn’t place enough value on prenatal care.

But there is universal agreement that one factor—premature birth—guarantees low birth weight. And the number of babies born prematurely is on the rise, up 29 percent since 1981, according to the March of Dimes, a nonprofit organization dedicated to improving the health of babies by preventing birth defects, premature birth and infant mortality. In part, that is due to increased use of fertility drugs, which has led to a higher percentage of pregnant women carrying two or more babies at once, a risk factor for premature birth.

Still, Agatha Lowe, assistant commissioner of women’s and children’s health programs for the Chicago Department of Public Health, says there has been little improvement in the rate of low weight births because the causes are complex and doctors don’t always know what causes a baby to be born tiny.

What is certain, however, is that the risks of being born too small can be serious. Medical advancements mean smaller babies can survive, but some face challenges for the rest of their lives, says Lowe.

Low-birth-weight babies are 25 times more likely to have brain damage or birth defects and are more likely to spend extra time in the hospital, says Laura Leon, acting executive director of the Illinois Maternal and Child Health Coalition. Sims says something as inconsequential as a shift in the weather can be enough to make Shaayla sick.

Chicago’s challenge

A 12-year review of Chicago’s community-based primary care system released last year by the Chicago Department of Public Health shows that the number of underweight babies born over that period did decrease. But a similar decrease in the number of total births kept the rate of low weight births at 10 percent.

Lowe says the city is working to reduce the rate, however."Programs are targeting women most at risk for low-birth-weight babies and trying to make sure they receive health care consistently and early, and the health problems they have are improved before they become pregnant,” she says.

Those most at risk include women with health issues during or prior to pregnancy; women who already have a child born at a low birth weight; women who smoke, drink alcohol or abuse drugs and women with lower income and education levels. Race also is a risk factor—African-American women are more than twice as likely as white or Hispanic women to deliver a low-birth-weight infant locally, says Lowe. The federally funded Closing the Gap Initiative runs a program in Chicago aimed at eliminating that racial disparity.

Improving birth weights

Many factors put women at risk for delivering tiny newborns, but local health professionals offer these tips to increase the chances of delivering a healthy baby:

• Attend prenatal appointments early and often. This allows doctors to identify problems from the start and make sure the baby is gaining weight.

• Visit the dentist and the doctor before getting pregnant. Periodontal (gum) disease and a vaginal infection called bacterial vaginosis both involve a build-up of harmful bacterial that can spread to other parts of the body and lead to early labor, says Leon.

• Don’t douche. Douching washes away healthy bacteria in the vagina, allowing unhealthy bacteria to grow, says Leon.

• Space your pregnancies. Lowe recommends leaving 18 months between pregnancies to allow your body to recover. Spacing is even more important for women who have previously delivered a low-birth-weight baby. It gives the doctor additional time to determine why the baby was born too small.

• Be healthy. Make sure chronic health problems such as diabetes or hypertension are under control before trying to become pregnant, Lowe says.

• Stop smoking, drinking alcohol and abusing substances and start eating right."It’s what most of us are supposed to be doing,” she says.

Hannah Schroder is a writer living in Chicago and a former Chicago Parent intern.

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