Low birthweight and short gestation have been added for GBD 2016; they are the third-leading global risk at Level 3 in the GBD risk hierarchy. Improvements in burden attributable to low birthweight and short gestation have been largely driven by other factors influencing neonatal death rates, given that exposure to low birthweight and short gestation have not improved much over the past 27 years. Little progress in exposure suggests suboptimal coverage of interventions and programmes that can prevent low birthweight and short gestation. These include women-centred services for optimising nutrition (including minimising obesity), infection control, smoking cessation, and preventive care for pregnant women or those contemplating pregnancy.45, 46, 47 Efforts should also focus on maximising the quality of antenatal care services to identify and appropriately manage at-risk and high-risk pregnancies,48 including avoidance of provider-initiated preterm delivery. If evidence-based interventions are employed, it should be possible even in resource-limited settings to shift the risk curve for those babies who will be born early, small, or both, despite best efforts. Before birth, this includes potentially antenatal steroid administration to promote lung development;49
