Sir.—I hesitate to criticize the article "A Model for Studying the Pathogenesis and Incidence of Low-Birth-Weight Infants" (Journal 1983;137: 323-327) by such an expert as Dr Miller, and the related editorial "Continuing Challenges in Reduction of Neonatal Mortality" (Journal 1983;137: 321-322) by Dr Avery. However, I would just like to point out to pediatric readers that the one clear association between low-birth-weight infants and maternal pathologic conditions is relative maternal hypovolemia.1,2 Indeed, it is rare to find a growth-retarded fetus in the presence of normal expansion of the maternal plasma volume. Growth-retarded newborns are associated with high maternal hemoglobin levels, not low ones.2 In my experience, the best indicator of pregnancy well-being is a decrease in maternal hematocrit values during the 18th to 34th weeks of gestation.
GOODLIN RC. Pathogenesis and Low-Birth-Weight Infants. Am J Dis Child. 1983;137(10):1025. doi:10.1001/archpedi.1983.02140360085028