MCH Alert: Focus on Infant Mortality


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.mchlibrary.info/suid-sids/alert/archives.html.


June 27, 2008

1. Brief Outlines Opportunities to Improve Preconception Health and Health Care
2. Analysis Examines Surveillance Data on Assisted Reproductive Technology Procedures and Outcomes
3. Study Explores Relationship Between Obesity and Neonatal Mortality in Black Women and White Women
4. Randomized Controlled Trial Investigates the Safety of Dental Treatment in Pregnant Women

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Special Notices:

Prevention of Tobacco Use and Secondhand Smoke Exposure Before, During, and After Pregnancy highlighted research, information, and programs at the national, state, and local levels on smoking cessation among pregnant and parenting women. The Webcast, presented on June 19, 2008, by the National Association of City and County Health Officials, included a discussion of systems-level approaches to smoking cessation among pregnant and parenting women, as well as the connection between environmental tobacco smoke and infant health. The Webcast archive is available at http://webcasts.naccho.org/session-archived.php?id=1446.

The Surgeon General's Conference on the Prevention of Preterm Birth convened experts and community leaders from the research, public health, and medical communities in preliminary discussions to inform a national agenda to prevent preterm birth. The Webcast, presented on June 16-17, 2008, by the Office of the Surgeon General in partnership with public and private organizations, was based on existing recommendations from the Institute of Medicine’s (IOM's) 2006 report on preterm birth and emerging literature concerning activities needed to help prevent preterm birth. The agenda and background materials, including the IOM reports, workgroup reports, and information on the Prematurity Research Expansion and Education for Mothers Who Deliver Infants Early (PREEMIE) Act, are available at http://www.nichd.nih.gov/about/meetings/2008/SG_pretermbirth.cfm.

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1.BRIEF OUTLINES OPPORTUNITIES TO IMPROVE PRECONCEPTION HEALTH AND HEALTH CARE

Healthy Women, Healthy Babies identifies issues and obstacles facing the United States in promoting preconception care and recommends further actions to enhance women's health, and, consequently, to ensure healthier infants. The issue brief, produced by Trust for America's Health with support from the Annie E. Casey Foundation, is presented in the following five parts: (1) overview; (2) moving into a new era of well-woman care; (3) challenges; (4) federal, state, and local initiatives; and (5) recommendations for preconception care. Topics include the need for preconception care to become an integral part of primary and preventive care for all women and for all couples and the role of local health departments in promoting preconception health, linking women to needed services, and providing care in underserved areas. Additional topics include health disparities, insurance coverage, clinical practice, health conditions and high-risk behaviors that affect pregnancy outcomes, and strategies to reduce risk and improve outcomes. The report is available at http://healthyamericans.org/reports/files/BirthOutcomesLong0608.pdf.

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2. ANALYSIS EXAMINES SURVEILLANCE DATA ON ASSISTED REPRODUCTIVE TECHNOLOGY PROCEDURES AND OUTCOMES

"Balancing the chance of success of ART [assisted reproductive technology] against the risk for multiple births is challenging," state the authors of a report published in the June 20, 2008, issue of Morbidity and Mortality Weekly Report Surveillance Summaries. ART includes fertility treatments in which both eggs and sperm are handled in the laboratory (i.e., in vitro fertilization and related procedures). The use of ART has increased steadily in the United States since 1996, when ART surveillance began. The primary focus in collecting ART data has been on live-birth deliveries as an indicator of success. However, success-rate data should be balanced with consideration of effects on maternal and infant health. Data collected on pregnancy outcomes of public health significance enables monitoring of risks associated with ART. The emphasis of this report is on presenting state-specific data and more detailed data about risks (e.g., multiple births, preterm delivery, and low birthweight) associated with ART.

The report is based on ART surveillance data provided to the Centers for Disease Control and Prevention (CDC) relevant to procedures performed in 2005. Data collected include patient demographics, medical history and infertility diagnoses, clinical information pertaining to the ART procedure, and information on resultant pregnancies and births. The data file is organized with one record per ART procedure performed. Multiple procedures from a single patient are not linked.

The authors found that
"Implementation of approaches to limit the number of embryos transferred for patients undergoing ART should reduce the occurrence of multiple births resulting from ART," state the authors. They conclude that "continued research is needed to understand the adverse effects of ART on maternal and child health."

Wright VC, Chang J, Jeng J, et al. 2008. Assisted reproductive technology surveillance -- United States, 2005. MMWR Surveillance Summaries 57(SS05):1-23. Available at http://www.cdc.gov/mmwr/preview/mmwrhtml/ss5705a1.htm?s_cid=ss5705a1_e.

Readers: More information is available from the following MCH Library resource:

- Assisted Reproductive Technologies: Selected Resources at
http://www.mchlibrary.info/guides/ART.html

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3. STUDY EXPLORES RELATIONSHIP BETWEEN OBESITY AND NEONATAL MORTALITY IN BLACK WOMEN AND WHITE WOMEN

"Our study found maternal obesity to be an independent risk factor for neonatal mortality among blacks but not whites," state the authors of an article published in the June 2008 issue of Obstetrics and Gynecology. During the previous two decades, the prevalence of obesity (particularly morbid or extreme obesity) has been rising continuously in the United States, especially among women. Currently, information on the association between obesity and neonatal survival is sparse. The study described in this article sought to estimate the effect of maternal obesity on neonatal survival using a data source that has consistently obtained pre-pregnancy body mass index (BMI) indices as well as infant survival data for almost two decades. Although the article focuses primarily on maternal obesity in general, the authors also examine gradation of obesity as well as obesity-related black-white disparity in neonatal survival.

Data for the study comes from Missouri maternally linked cohort data files covering the period 1978-1997. The authors selected singleton live births within the gestational age range of 20-44 weeks. BMI was used to define maternal pre-pregnancy weight groups. Women were assigned to the following BMI-based categories: normal (18.5-24.9), class I obesity (30.0-34.9), class II obesity (35.0-39.9), and morbid or extreme obesity (40 or higher). The authors considered information on the following maternal characteristics to evaluate any differences in sociodemographic features between obese and non-obese mothers: race (black or white), maternal age, marital status, educational status, cigarette smoking during pregnancy, and adequacy of prenatal care. The outcome of interest was neonatal mortality, which was defined as death occurring between the day of birth (day 0) and 27 days after birth (day 27). Neonatal mortality was further subdivided into early neonatal mortality (days 0-6) and late neonatal mortality (days 7-27).

The authors found that
The authors conclude that "the results suggest a possible avenue for targeting interventions that aim to reduce the black-white disparity in infant survival, a problem that has been persistent for decades in the United States."

Salihu HM, Alio AP, Wilson RE, et al. 2008. Obesity and extreme obesity: New insights into the black-white disparity in neonatal mortality. Obstetrics and Gynecology 111(6):1410-1416. Abstract available at http://www.greenjournal.org/cgi/content/abstract/111/6/1410.

Readers: More information is available from the following MCH Library resources:

- Infant Mortality: Knowledge Path at
http://www.mchlibrary.info/KnowledgePaths/kp_infmort.html

- Pregnancy and Preconception: Knowledge Path at
http://www.mchlibrary.info/KnowledgePaths/kp_pregnancy.html

- Racial and Ethnic Disparities in Health: Knowledge Path at
http://www.mchlibrary.info/KnowledgePaths/kp_race.html

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4. RANDOMIZED CONTROLLED TRIAL INVESTIGATES THE SAFETY OF DENTAL TREATMENT IN PREGNANT WOMEN

"In this population, periodontal treatment and EDT [essential dental treatment], administered at 13 to 21 weeks' gestation, did not significantly increase the risk of any adverse outcome evaluated," state the authors of an article published in the June 2008 issue of the Journal of the American Dental Association. Collectively, recent findings suggest that use of oral health services during pregnancy may be driven more by attitudes than by economics or convenience. Attitudes and behaviors may be influenced by fear of harm to the pregnant woman or fetus, fear of litigation, or patient safety concerns. The article describes safety outcomes related to the provision of oral health care in pregnant women.

Data for the study were drawn from a multi-center randomized controlled clinical trial (the Obstetrics and Periodontal Therapy [OPT] Trial) conducted to determine whether periodontal therapy in pregnant women reduces the risk of preterm delivery. The study sample included women recruited from obstetrics clinics serving minority and other underserved groups who are at an elevated risk of experiencing preterm birth. All women had periodontitis. A total of 413 women were randomly assigned to receive scaling and root planing at a time before 21 weeks' gestation. The 410 women in the control group were monitored during their pregnancy and treated with scaling and root planing after delivery. Women in both groups were also evaluated for EDT needs (defined as the presence of moderate-to-severe caries or fractured or abscessed teeth). The analysis examined associations between adverse pregnancy outcomes (spontaneous abortion or fetal death, pregnancy ending before 37 weeks' gestation, fetal or congenital anomaly) and EDT, anesthetic use during nonsurgical periodontal treatment, and combinations of EDT and periodontal treatment.

The authors found that
"Several ongoing randomized controlled intervention trials should help to define more precisely the risk of adverse pregnancy outcomes associated with nonsurgical periodontal procedures, including the risk of spontaneous abortion and stillbirth," state the authors. "Nevertheless," the authors conclude, "our study provides evidence that dental care providers can safely meet the preventive and routine treatment needs of their pregnant patients."

Michalowicz BS, DiAngelis AJ, Novak MJ, et al. 2008. Examining the safety of dental treatment in pregnant women. The Journal of the American Dental Association 139(6):685-695. Abstract available at http://jada.ada.org/cgi/content/short/139/6/685.

Readers: More information is available from the following MCH Library resource:

- Oral Health and Pregnant Women, Infants, Children, and Adolescents at
http://www.mchlibrary.info/KnowledgePaths/kp_oralhealth.html

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MCH Alert © 1998-2008 by National Center for Education in Maternal and Child Health and Georgetown University. MCH Alert: Focus on Infant Mortality is produced by Maternal and Child Health Library at the National Center for Education in Maternal and Child Health under its cooperative agreements (U02MC00001 and U48MC08717) with the Maternal and Child Health Bureau, Health Resources and Services Administration, U.S. Department of Health and Human Services. The Maternal and Child Health Bureau reserves a royalty-free, nonexclusive, and irrevocable right to use the work for federal purposes and to authorize others to use the work for federal purposes.
 
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MANAGING EDITOR: Jolene Bertness
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COPYEDITOR/WRITER: Ruth Barzel
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