Babies’ birthweight and other birth outcomes affect their health, development and learning during the early years, which impacts third grade reading outcomes.
Babies born weighing less than 5.5 pounds are at greater risk for physical, developmental and learning problems than infants of normal weight, including:
- Short- and long-term illness or disability
- Learning disorders
- Behavioral problems
- Enrollment in special education classes
- Grade retention
- School failure1
Low birthweight babies generally score lower on reading, passage comprehension, and math achievement tests.2
Low birthweight impacts black babies at a higher rate than white babies, regardless of mother’s income. Effective strategies to improve healthy birthweight rates focus on pre-pregnancy health, with a particular focus on supporting women of color.
- Schorr et al, Pathway to Children Ready for School and Succeeding at Third Grade. op cit. ↵
- Michigan News. (2007, June 5). Born to lose: How birthweight affects adult health and success. Retrieved from http://ns.umich.edu/new/releases/5882-born-to-lose-how-birth-weight-affects-adult-health-and-success ↵
What Can We Do About It?
What supports healthy birthweight?
- Policies and practices that focus on improving women’s general pre-pregnancy health (including addressing unhealthy behaviors) and prenatal and inter-conception care, with particular attention to groups at high risk for low birthweight births.
- Two-generation approaches and evidence-based programs that support mothers’ health, provide parenting education and support, and support children’s health and learning.
North Carolina’s Perinatal Health Strategic Plan: North Carolina adapted national research to develop a 12-point framework designed to improve health care prenatally and between pregnancies, enhance the coordination of services, and address inequities. The plan is in the implementation phase.1
Improving Community Outcomes for Maternal and Child Health: This initiative within the North Carolina Department of Health and Human Services will fund evidence-based strategies to improve birth outcomes and reduce infant mortality. It will focus on
- Use of long-acting reversible contraceptives
- Smoking cessation and prevention
- Triple P interventions.2 Triple P is a parenting education program that aims to increase the knowledge, skills and confidence of parents and reduce mental health, emotional and behavioral problems in children.
- North Carolina’s Perinatal Health Strategic Plan: 2016-2020. (2016). North Carolina Department of Public Health. Retrieved from https://buildthefoundation.org/wp-content/uploads/2018/03/PHSP-FINAL-website-10-31-16.pdf ↵
- ImprovingCommunity Outcomes for Maternal and Child Health (ICO4MCH). (2017). http://www.ncalhd.org/wp-content/uploads/2017/02/ICO4MCH-Overview.pdf ↵
What Works for Third Grade Reading: Healthy Birthweight
considers why a healthy birthweight matters for third grade reading proficiency, outlines its connections with other factors that impact early literacy, and highlights options that have been shown to move the needle on low birthweight and premature births. It is one of 12 new working papers that offer research-based policy, practice and program options to states and communities working to improve third grade reading proficiency.
Research Basis for Pathways Measures of Success Framework
This resource provides data definitions of the Measures of Success and shares the research for each measure, demonstrating the connections between the measures and third-grade reading proficiency. A list of sources is included for each group of measures.
Investing in North Carolina's Healthy Future
A fact sheet to highlights the interconnectedness of health and learning.
What Works for Third Grade Reading: An Overview of the NC Pathways to Grade-Level Reading
The paper provides an introduction to a series of 12 working papers that offer research-based policy, practice and program options to states and communities working to improve third grade reading proficiency. Read this document first before delving into the papers.
Related News Posts
More About Healthy Birthweight
Risk Factors for Low Birthweight
Race/Ethnicity. Low birthweight and pre-term birth are highly connected. The risk of both varies by race, ethnicity, and the presence of trauma and toxic stress in a mother’s life. Nationally, about one in ten babies were born preterm in 2013. Black babies are most affected, regardless of mothers’ income levels. They are 60% more likely to be born preterm than white babies, and 44% more likely to be born preterm than Hispanic babies.1
Maternal health and availability of prenatal care.2
- Both preterm and low weight births are highly connected with smoking, alcohol, and drug use during pregnancy.3 Timely prenatal care can help prevent tobacco and substance use.
- In the Southeast, efforts to provide improved prenatal care have not been enough to address low birthweight. One reason may be a failure to address risk factors unique to black mothers.4 These risks include the toxic stress of living with structural racism. Barriers to prenatal care include poverty, cash flow to pay co-pays, transportation, distance to medical care, and knowledge of the pregnancy.5
Poverty and lack of health insurance threaten a mother’s health during pregnancy. Babies of homeless mothers are four times more likely to be of low birthweight and require specialized care than other babies.6 The effects of being born at a low birthweight are compounded for babies who do not have health insurance and impact their health into adulthood.7 In fact, large racial differences in adult health are thought to be fully explained by a few early life factors: birthweight, parental income, and health insurance coverage.8
Maternal age. Being younger than 17 or older than 35 increases the likelihood of having a low birthweight baby.9 Teen mothers are also more likely to have a second baby quickly after the first, increasing the risk of a low-weight birth.10
Elective deliveries (c-sections). The outcomes of c-sections are mixed.
- In general, elective delivery increases the likelihood of a low weight birth.11 Ten to 15% of births in the U.S. are early elective deliveries. The U.S. Department of Health and Human Services estimates that a 10% reduction in deliveries before 39 weeks of gestation could save more than $75 million in Medicaid resulting from birth complications.12
- Within the population of Medicaid-eligible women, however, cesarean section rates are 30% lower than the rates for privately insured women, and for Medicaid-eligible women, c-sections tend to improve infant health.13
- March of Dimes. (n.d.). Racial and Ethnic Disparities in Birth Outcomes: Fact Sheet. Retrieved from http://www.marchofdimes.org/materials/March-of-Dimes-Racial-and-Ethnic-Disparities_feb-27-2015.pdf ↵
- Anum, E.A., Retchin, S.M, and Strauss, J.F. (2004). Medicaid and Preterm Birth and Low Birthweight: The Last Two Decades. Originally published in the Journal of Women’s Health, 19(3): 443-451. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2867587/. ↵
- Behrman, R., Butler, A. (2007). Behavioral and Psychosocial Contributors to Preterm Birth. Preterm Birth: Causes, Consequences, and Prevention (3). Retrieved from https://www.ncbi.nlm.nih.gov/books/NBK11361/ ↵
- Medicaid and Preterm Birth and Low Birthweight, op cit. ↵
- North Carolina Pregnancy Risk Assesment Monitoring System (PRAMS). (2005). Barriers to Prenatal Care. NC PRAMS Fact Sheet. Retrieved from http://www.schs.state.nc.us/schs/prams/pdf/BarriersToPrenatal.pdf ↵
- Firth, P. (2014). Homelessness, Poverty and the Brain: Mapping the Effects of Toxic Stress on Children. Retrieved from http://firesteelwa.org/2014/09/homelessness-poverty-and-the-brain-mapping-the-effects-of-toxic-stress-on-children/ ↵
- Born to lose, op cit. ↵
- Born to lose, op cit. ↵
- March of Dimes. (n.d.). Low birthweight. Retrieved from http://www.marchofdimes.org/complications/low-birthweight.aspx ↵
- March of Dimes, op cit. ↵
- Born Too Early: Improving Maternal & Child Health by Reducing Early Elective Deliveries. (2014). NIHCM Issue Brief, National Institute for Health Care Management Foundation. Retrieved from: https://www.nihcm.org/pdf/Early_Elective_Delivery_Prevention_Brief_2014.pdf ↵
- Goodwin, K. Smart. (2014). Smart Investments in Children’s Health. Retrieved from http://www.ncsl.org/documents/health/SmartInvestments914.pdf ↵
- Alexander, D. (2015). Does Physician Pay Affect Procedure Choice and Patient Health? Evidence from Medicaid C-section Use. Retrieved from: http://scholar.princeton.edu/sites/default/files/dalexand/files/procedure_choice_6_15.pdf ↵
Healthy Birthweight in North Carolina
Low birthweight and premature birth rates highlight race, ethnic and geographic inequities in North Carolina. In 2016, about one in ten babies (9.2%) were born prematurely. Rates were higher among Black women at 14.1% and Native American women at 12.6%. The rate for “other, non-Hispanic” women was 9.2%. The rate was lower for white, non-Hispanic women at 7.6%, and Hispanic women were the least likely to have babies born with low birthweight, at 7.4%. Data from 2014 show that five of North Carolina’s major cities had average pre-term birth rates above the state average:
- Charlotte: 10%
- Greensboro: 10.4%
- Durham: 9.9%
- Fayetteville: 10.9%
- Winston-Salem: 12%.1
North Carolina’s Healthy People 2020 strategic plan has a goal to reduce the prevalence of low weight births to 6.3% by 2020. This is an average reduction across populations. It does not identify goals for specific racial groups in the state that have higher rates.2 The plan also aims to reduce the percentage of women who smoke during pregnancy, a risk factor for low weight births.
- March of Dimes. (2016). 2016 Premature Birth Report Card. Retrieved from http://www.marchofdimes.org/materials/premature-birth-report-card-north-carolina.pdf ↵
- Healthy North Carolina 2020: Focus Areas, Objectives, and Evidence-Based Strategies. (n.d). Retrieved from http://publichealth.nc.gov/hnc2020/objectives.htm ↵