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 and Unexpected Infant/Child and Pregnancy Loss Resource Center at Georgetown University. This and past issues are available online at http://www.mchlibrary.info/alert/archives.html and http://www.sidscenter.org/alert/archives.html.

April 30, 2010

Readers: This issue includes summaries that reference stillbirth and perinatal death. The terms "stillbirth," "perinatal death," and "perinatal loss" are often used interchangeably. In writing these summaries, we have tried to use terms as accurately as possible while also being true to the language used in the original articles.

Multimedia Featured Resource: Community Journeys to Reduce Infant Mortality by Addressing Racism: Translating Learning into Action describes how three national organizations and six communities across the country worked together to translate research and knowledge into action around racism. The Webinar was co-produced by CityMatCH and the National Association of County and City Health Officials as part of the Emerging Issues in MCH (E-MCH) series, presenting current research, policy, and practice strategies on critical issues in public health. The Webinar detailed the Infant Mortality and Racism Action Learning Collaborative, an activity of the Partnership to Eliminate Disparities in Infant Mortality. The partnership, which aims to decrease racial disparities in infant mortality in urban areas, comprises CityMatCH, the Association of Maternal and Child Health Programs, and the National Healthy Start Association and is supported by the W.K. Kellogg Foundation. Webinar topics included (1) key differences between health disparities and health equity, (2) processes by which teams can effectively approach and address racism, (3) the role of local and state health departments and other community organizations in reducing infant mortality by addressing racism, and (4) resources for local health departments. The Webinar archive (presenter information, recording, and materials) is available at https://cc.readytalk.com/cc/schedule/display.do?udc=n39dse7u2d95

1. TOOLKIT PROVIDES GUIDANCE ON CREATING PRACTICE ENVIRONMENTS WHERE CLIENTS OF ALL LITERACY LEVELS CAN THRIVE

Health Literacy Universal Precautions Toolkit provides step-by-step guidance and tools for physicians and other primary care health professionals to use in assessing a practice and making changes to promote better understanding for clients of all literacy levels. The Agency for Healthcare Research and Quality commissioned the University of North Carolina at Chapel Hill to produce the toolkit. Contents include tools for practice change, video, documents, Internet resources, testimonials from a practice, tips, and key points. Topics include an overview of health literacy universal precautions, steps to implement the toolkit, and instructions on identifying and addressing areas that need improvement (spoken and written communication, self-management and empowerment, and supportive systems). The appendix contains resources such as forms, PowerPoint presentations, worksheets, and posters that support the implementation of the tools. The toolkit and additional resources related to the toolkit are available at http://www.ahrq.gov/qual/literacy

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• The analyses included 804 completed surveys (response rate = 54 percent).
• Twenty-seven percent of physicians responded that, following a perinatal death, parents could try to conceive "as soon as they feel ready"; 10 percent recommended waiting for one or more normal menses; 33 percent recommended two to five normal menses; and 31 percent recommended waiting 6 or more months.
• Forty-five percent of physicians responded that parents would not be emotionally ready to conceive until 6 or more months after a perinatal death; 40 percent responded "as soon as they feel ready"; 1 percent recommended one or more normal menses; and 13 percent recommended two to five normal menses.
• Thirty-two percent of physicians responded that parents would not be medically ready to conceive until 6 or more months after a perinatal death; 9 percent responded that parents would be medically ready "as soon as they are ready"; 19 percent recommended one or more normal menses; and 40 percent recommended two to five normal menses.
• Forty-two percent of physicians responded that parents "often" or "usually" wait to conceive as long as suggested; 13 percent responded that parents "rarely" or "not so often," waited; and 44 percent responded, "it varies."

• A total of 1,408 (61 percent) mothers reported usually placing their infants supine to sleep; 489 (21 percent) lateral; 390 (17 percent) prone; and 12 (0.5 percent) another position.
• The percentage of mothers who placed their infants supine increased with higher advice scores (number of sources of advice for exclusively supine sleep minus number of sources of advice for not exclusively supine sleep).
• Mothers who believed their infants were most comfortable supine were more likely to usually place their infants supine; those who believed that infants were most likely to choke supine were significantly less likely to usually place their infants supine.
• Advice for exclusively supine sleep from most sources was associated with higher odds of usual supine sleep position after adjustment for covariates.
• Throughout the analyses, mothers' beliefs about infant comfort and choking remained significant. Race-ethnicity, a significant predictor of usually supine infant sleep in the initial analysis, became nonsignificant once mothers' beliefs were included and remained nonsignificant in all subsequent models.

• Overall, women who experienced pre-eclampsia in their first pregnancy had a 43 percent increased risk of stillbirth in their second pregnancy.
• Whereas women with a history of late-onset pre-eclampsia had no elevated risk of stillbirth when compared with women who did not experience pre-eclampsia in their first pregnancy, women whose first pregnancy resulted in early-onset- pre-eclampsia had a more than fourfold increased risk of stillbirth in their second pregnancy.
• Black women whose prior pregnancies resulted in early-onset pre-eclampsia had a more than eightfold increased risk of stillbirth compared to their counterparts whose prior pregnancies were free of the disease. By contrast, the risk of stillbirth in black women with late-onset pre-eclampsia in their first pregnancy was not different from that of black women without pre-eclampsia in their first pregnancy.