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July 12, 2002


Alfred Brann, M.D., Leads New Low Birth Weight Program At Grady Memorial Hospital

A joint program being spearheaded by the Emory University departments of gynecology and obstetrics and pediatrics at Grady Memorial Hospital seeks to reduce the number of low-birth weight, premature infants in Georgia – especially those born year after year to the same at-risk women.

"The major cause of infant mortality in Georgia is that there are too many tiny babies being born here," said neonatologist Alfred Brann, M.D., professor of pediatrics with the Emory University School of Medicine at Grady Hospital. Brann is also director of the World Health Organization Collaborating Center in Reproductive Health (WHO/CC/RH), whose mission is improving the poor reproductive outcomes of women in Georgia.

Dr. Brann and Luella Klein, M.D., professor of obstetrics and gynecology with the Emory University School of Medicine, are leading the Interpregnancy Care Project. Interpregnancy care, by definition, is care given during the time between the birth of a womanÕs last child and her next pregnancy.

As part of the project, Dr. Brann and Dr. Klein will develop strategies for women who have had very low birth weight babies at Grady.

"So far, no strategies have been defined to identify which woman is going to have her first baby prematurely. The challenge is to know which women to concentrate on," Dr. Brann said.

Data strongly links low birth weight and pre-term births (in singleton pregnancies) as the strongest predictor of women who are at risk for having another very low birth weight infant. Strategies for the program, which is set to begin in early fall, will address the broader needs of the woman and her access to basic health services to improve her health status. The strategy of Interpregnancy Care is especially important for women who have had very low birth weight infants and are at risk for a subsequent pregnancy.

"The purpose of the project is to evaluate the effectiveness this program will have in improving pregnancy outcomes for women who have very low birth weight babies," Dr. Brann said.

A study by the Task Force on the Georgia Perinatal Program, for example, recently found that premature or low birth weight babies who weigh 1,500 grams or less – which is about three-and-a-half pounds - account for 50 percent of GeorgiaÕs infant mortality rate. Georgia ranks among the top 10 states with both the highest infant mortality and low birth weight rates in the country. Low birth weight leads to compounding problems; not only is it the leading cause of most infant deaths, but it results in extremely disabling and expensive health problems among surviving low birth weight children. Over the past 15 years in metro Atlanta, cases of cerebral palsy have increased, as has the number and survival of low birth weight babies.

The first strategy of the Interpregnancy Project will be to improve the health of the woman who has had a very low birth weight infant. This will be done by identifying specific medical and social risks that the mom may have. Another strategy involves assisting the woman in achieving her reproductive goals, which include a planned pregnancy with an interval of at least six to 18 months before she has a second child.

"We think pregnancy is too late to start trying to prevent a premature birth," Dr. Brann noted. "The approach is to help the woman delay pregnancy, get her health up to par, and then have a planned pregnancy."

Previously, most interventions for women with spontaneous pre-term labor have focused on women after they are pregnant.

"Currently, the strategies that offer the greatest potential for increasing a high-risk womanÕs chance of having a full-term, normal, healthy baby are either preconception or interpregnancy care," Brann said.

The Interpregnancy Care Project is being developed through a partnership between the Emory University component of the WHO/CC/RH and funds from the Vasser-Wooley Foundation, the Rockdale Foundation, Centers for Disease Control and Prevention, the Georgia Chapter of the March of Dimes, and Grady Memorial Hospital. It is expected to last four years.

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