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.

April 25, 2008

1. MCHB ANNOUNCES INITIAL RELEASE OF DISCRETIONARY GRANT WEB REPORTS

The Discretionary Grant Information System (DGIS) Web reports display financial, national performance measure, and abstract data collected annually from more than 900 grants issued by the Health Resources and Services Administration (HRSA), Maternal and Child Health Bureau (MCHB), including data from grants to reduce disparities in infant mortality. The public reports contain data collected by MCHB via a Web-based system that allows grantees to report their data online as a part of the grant-application and performance-reporting processes. Data contained in the reports help MCHB assess the effectiveness of its programs and help staff monitor the progress made under these grants. The DGIS complements the existing Title V Information System (TVIS), which electronically captures data from the annual Title V Block Grant applications and reports submitted by all 59 U.S. states, territories, and jurisdictions. The TVIS provides information on key measures and indicators of maternal and child health (MCH) in the United States. The DGIS and Title V reports are intended for use by public health professionals, researchers, and the public in accessing concise information about programs working to improve the quality of and access to health care for MCH populations. Additional reports to be released in the future will focus on other program and performance measure data. The DGIS reports and the TVIS are available at http://www.mchb.hrsa.gov/data.

• There were almost 6.4 million pregnancies in 2004 among women of all ages, about 6% fewer than the nearly 6.8 million in 1990.
• Pregnancy rates for women under age 25, including teenagers, declined in 2004 compared with 1990.
• Women ages 25-29 had the highest pregnancy rate, at 169 per 1,000, closely followed by women ages 20-24, at 164 per 1,000.
• The pregnancy rate for married women declined by 12% from 1990 to 1996-1997. From 1997 to 2000, the rate increased by about 5% and varied little through 2004.
• The pregnancy rate for unmarried women declined continuously from 1990 to 1999, falling by 13%. The rate changed little through 2004.
• Pregnancy rates declined steadily for teenagers from 1990 to 2004, by 38% overall.
• More than two-thirds of pregnancies to non-Hispanic white women (69%) and Hispanic women (67%) and half of pregnancies to non-Hispanic black women ended in live birth.
• Pregnancy rates and birth rates were much higher at the younger ages for black and Hispanic women than for white women, despite the widespread declines in pregnancy rates at ages 15-24 from 1990 through 2003.
• Three out of four pregnancies (75%) among married women ended in a live birth in 2004, while 19% ended in a fetal loss, and 6 percent ended in abortion. For unmarried women, slightly over half of pregnancies (51%) ended in a live birth, an increase from 43% in 1990. Thirty-five percent of these pregnancies ended in abortion, and 13% ended in fetal loss.

• In the cohort 44 weeks or less PMA, the SSIDS, ALTE, and preterm infants were at significantly increased risk for at least one extreme event, compared with healthy term infants. However, the effect disappeared after 43 weeks PMA (well before the peak incidence of SIDS).
• None of the SIDS risk factors were significantly related to having at least one extreme event.
• Infants whose mothers smoked during pregnancy had significantly fewer conventional events.
• Infants were less likely to have an extreme event in the early morning hours (between 4:00 a.m. and 7:00 a.m., when infants tend to be at higher risk of SIDS) than earlier in the night.
• The incidence of conventional events was higher between 10:00 p.m. and 1:00 a.m. and between 1:00 a.m. and 4:00 a.m. than between 4:00 a.m. and 7:00 a.m.
• Nineteen infants (1.8%) exhibited apneic episodes of 40 seconds or longer.

• Fetal outcome is significantly associated with crash severity, such that minor crashes are more likely to result in acceptable fetal outcomes, whereas severe crashes are more likely to produce adverse fetal outcomes.
• Fetal outcome is strongly associated with severity of maternal injury, with more serious fetal outcomes associated with more severe maternal injury.
• An 84% reduction in risk of adverse fetal outcome is obtained if the pregnant occupant properly wears a seatbelt.

• At 18 to 22 months, 49% of the study infants had died, 61% had died or had profound impairment, and 73% had died or had impairment.
• Increased birthweight, female sex, any use of antenatal corticosteroids, and singleton birth were each associated with reductions in risks of death and of death or profound or any neurodevelopmental impairment; these reductions were similar to those associated with a 1-week increase in gestational age.
• At the same estimated likelihood of a favorable outcome, the likelihood of receiving intensive care was lower for girls than for boys and for singletons than for multiples.
• The outcomes of the infant risk groups were predicted more accurately with the use of five factors (gestational age, birthweight, sex, exposure or nonexposure to antenatal corticosteroids, and single or multiple gestation) than with the use of gestational age alone.