WASHINGTON – Maryland babies get a healthier start than newborns in many other states, but Baltimore infants fare worse on average than babies in the nation’s 50 largest cities, according to a study released this week.
The study by Child Trends and Kids Count tracked eight measures of a healthy birth — including smoking during pregnancy, maternal education level and timeliness of prenatal care — between 1990 and 1998. Maryland did better than the national average on five out of eight measures in 1998.
But Baltimore, despite significant improvements in some areas, did worse than most other large cities in all eight categories and ranked dead last in two — the percent of newborns with low birth weight and the percent of babies born to teen mothers.
Advocates said the city’s poverty explains the difference.
“Concentrated poverty has a big impact on measures,” said William P. O’Hare, a researcher with Kids Count and an author of the study.
Dr. Diana Cheng, chief of Maternal Health at the state Department of Health and Mental Hygiene, said she was not “surprised by any of those numbers at all. It’s what I expected.”
What surprised some advocates was the fact Maryland was not doing better, given the state’s relative affluence.
“Maybe as rich as we are, we can afford to spend a little more money on these programs,” O’Hare said.
Since 1990, the first year included in the report, Maryland has done consistently worse than the national average on three measures of a healthy birth — percent of low birth-weight babies, percent of premature births and percent of births to unmarried women. The gap between the state and national averages has actually widened slightly for the first two measures during the period.
Cheng said premature and low-weight births are the variables that doctors worry about the most, because they are often linked with later health problems. Babies with very low birth weight are particularly at risk, she said. Although some thrive, many do not.
“We’re talking about a future of problems — learning disabilities, medical problems, too. . .so that’s a factor we really want to combat,” she said.
But Cheng said there may be some explanations besides poverty.
She said, for example, that more and more Maryland women are delaying childbirth and turning to reproductive technology to enhance fertility. Such technology often results in twins or triplets or more, with subsequently lower birth weights and shorter terms.
“With multiple gestations, you have more premature births,” said Cheng. “They just tend to deliver earlier, they don’t go to term. I think that’s why we’re having an uphill battle with low birth weight and premature babies.”
She said Maryland has a large number of fertility centers and that sophisticated hospitals in the Baltimore area make fertility treatments an attractive option for a growing number of Maryland women. Cheng noted that the number of births to women aged 35 in Maryland jumped from about 10 percent in 1990 to almost 17 percent in 1998.
Maryland has consistently done better than the national average on four of the report’s eight measures: prenatal care, percent of births to teens, smoking during pregnancy and births to mothers with less than a high school education. In 1995, it moved above the national average on a fifth measure — births to teens who were already mothers — and it has remained there since.
Still, advocates say that something needs to be done to address the disparity throughout the state, which has one of the nation’s highest median incomes.
“If we’re the wealthiest state in the nation, it seems to be that we ought to be able to do better,” said Carol Fanconi, a health policy specialist for Advocates for Children and Youth. “It seems to me to be a have and have-not story.”