Maternal and Child Health Library

MCH Alert: Focus on Infant Mortality is developed by the Maternal and Child Health Library in collaboration with the National Sudden Infant Death Resource Center. This and past issues are available online at http://www.mchlibrary.info/alert/archives.html and http://www.sidscenter.org/alert/archives.html.

  March 28, 2008

1. DOCUMENTARY SERIES EXAMINES INFANT MORTALITY WITHIN THE CONTEXT OF RACIAL AND SOCIOECONOMIC INEQUALITIES

Unnatural Causes: Is Inequality Making Us Sick? is a seven-part documentary series that explores ways in which social conditions affect population health and how some communities are extending lives by improving these conditions. Conceived as part of a larger impact campaign in association with leading public health, policy, and community-based organizations, the series is a production of California Newsreel with Vital Pictures. Episode 2 in the series, titled When the Bough Breaks, specifically examines the conditions that surround and negatively impact African-American women and their infants. Information about the documentary series and series objectives, episode descriptions, video clips, a discussion guide, and transcripts are available from the series' Web site. A searchable database containing articles, Web sites, data, interviews, interactivities, case studies, and educational and outreach materials is also provided. More information is available at http://www.unnaturalcauses.org.

• Risk-adjusted mortality rates according to hospital ranged from 9.6% to 27.2%.
• Forty-nine percent of all white VLBW births occurred in the lowest mortality tertile of hospitals, compared with 29% of all black VLBW births. If black VLBW infants had been born in the same proportions in the same hospitals as white VLBW infants, then the estimated mortality rate for black infants would decrease by 4.8%, to 132.3 deaths per 1,000 VLBW births, reducing the black/white disparity in VLBW neonatal mortality rates in New York City by 34.5%.
• If black VLBW infants were born at high-volume hospitals at the same percentage as white VLBW infants, then the estimated mortality rate for black VLBW infants would be 137.1 deaths per 1,000 VLBW births, which represents a 1.4% decrease in mortality rates for black VLBW infants, and the black/white mortality rate disparity would decrease by 10%.

• The affective and behavioral reactions that typically occur following miscarriage seem similar to the affective and behavioral reactions that typically occur following other types of significant loss. At the same time, grief following miscarriage seems somewhat distinct from grief that typically occurs following other losses in the preponderant emphasis on times ahead rather than on remembered times.
• With regard to the percentage of individuals who experience a grief reaction following miscarriage, no clear guidelines can be formulated. The available literature does suggest that grief reactions are common and that the grief is similar in intensity to grief following other types of losses. In addition, like grief following other types of losses, grief after miscarriage seems to abate in intensity by about 6 months following the miscarriage.
• Gender differences in relation to grief following miscarriage are evident, with men seeming to experience less intense and enduring grief than women.
• Although many variables have been studied to determine their role as moderators of the intensity and duration of grief following miscarriage, few clear conclusions can be drawn.

• Overall, 172 women (16.18%) miscarried.
• Whereas 264 women (25%) reported no caffeine consumption during pregnancy, 635 women (60%) reported 0-200 mg of caffeine consumption per day, and 164 women (15%) reported 200 mg or more of caffeine consumption per day.
• Compared with non-users, women who consumed 0-200 mg of caffeine per day had an increased risk of miscarriage (15% vs. 12%), and the corresponding risk was much greater (25%) among women who consumed 200 mg or more per day.
• After adjusting for potential confounders, including maternal age, race, education, household income, marital status, previous miscarriage, smoking, alcohol consumption, Jacuzzi use, MF exposure, and nausea and vomiting, the hazard ratio of miscarriage was 1.42 and 2.23 for daily caffeine consumption of 0-200 mg and 200 mg or more, respectively.
• Caffeine's affect on the risk of miscarriage remained strong among women without a history of miscarriage, whereas the association no longer existed among women with such a history.