WASHINGTON – Maryland was among the worst states in the nation for low birth-weight and premature births in 1999, capping a decade in which its standing against other states steadily fell.
A study released Tuesday by the Annie E. Casey Foundation said that Maryland had the fifth-worst rate for newborns weighing less than 5.5 pounds, with 9 percent of babies here underweight compared to 7.6 percent nationally.
The state was sixth-worst for births before the 37th month of gestation, with 13.3 percent of babies in Maryland born prematurely compared to 11.8 percent nationally.
Researchers said the state may have been dragged down by Baltimore, which had the worst rankings of the 50 largest U.S. cities, and by the rising birthrate among blacks in the state.
“One thing that will make it difficult for Maryland to improve is that there is a much higher incidence for pre-term and low-birth weight births for African American women,” said Richard Wertheimer, senior research associate for Child Trends and co-author of the report.
Of the 72,000 births in Maryland in 1999, more than 24,000 were to black women. Maryland ranks fifth in the country for the number of minority births, said Dr. Maureen Edwards, medical director for the state’s Center for Maternal and Child Health.
Researchers are not sure why African Americans tend to have more premature and low birth-weight babies.
“People tend to blame . . . socioeconomic phenomena but that is not all of the story,” Edwards said. She pointed to studies of the military, for example, where everyone has the same access to health care, that still show a racial disparity in low birth-weight.
Edwards said one reason could be that some complications of pregnancy, such as hypertension, are more common among African American women. But low birth-weight is probably due to multiple factors and is most likely not genetic, she said.
Wertheimer also said Baltimore “clearly tends to hold down the performance of the state as a whole.”
The 10,000 births in Baltimore in 1999 accounted for 14 percent of the state total that year. Baltimore had more low birth-weight births than any of the cities to which it was compared and more premature births than most.
While Maryland women who gave birth tended to have had higher education levels and were less likely to smoke during pregnancy than in most other states, Baltimore, ranked worst in these categories among big cities.
And the city also had the highest percentage of women who smoked during pregnancy, at 17 percent, compared to the 9.8 percent of pregnant women statewide who smoked, earning Maryland a rank of 10th.
Edwards said the state’s diversity has to be taken into account when considering its rankings.
“For a lot of these things, we’re mixing the population so the average doesn’t necessarily tell the story for the individual woman,” she said.
The rate of premature and low-weight births rose both nationally and in Maryland during the 1990s, although the state rate rose faster and remained slightly higher. Part of the increase can be attributed to the rising use of fertility treatments, which have caused more multiple births, Wertheimer said.
Edwards said assisted reproductive technology is widely available in Maryland. Women who once had difficulty with pregnancy can now get pregnant, she said, but the treatment may cause multiple births or the women may not be able to carry a baby to full-term.
The report said the percentage of women who received late or no prenatal care in Maryland fell from 4 percent in 1990 to 3.1 percent in 1999.
But Edwards said prenatal care needs to be made more readily available in Maryland, and that transportation, support systems and cultural competence need to be assessed, in addition to increases in funding. The state should be asking if the woman finds prenatal care worthwhile and it meets her own health beliefs.
“We don’t have a specific statewide program to address these things,” she said.