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.

June 25, 2010

Multimedia Featured Resource: History, Highlights and Hope: Shattering the U.S. Infant Mortality Glass Ceiling was held on June 17, 2010. The Webinar was co-produced by the National Association of County and City Health Officials and CityMatCH as part of the Emerging Issues in Maternal and Child Health (MCH) series, with support from the Health Resources and Services Administration's Maternal and Child Health Bureau and the Centers for Disease Control and Prevention's National Center on Birth Defects and Developmental Disabilities Prevention. Topics included the history of U.S. efforts to reduce infant mortality; advances and successes in reducing infant mortality; current and emerging science, research, and vision for the future; and the role of local health departments and other community organizations in infant mortality reduction programs. The Webinar archive (presenter information, recording, and materials) is available at https://cc.readytalk.com/cc/schedule/display.do?udc=o7kewuje4j81

1. ARTICLE EXAMINES AFRICAN-AMERICAN MOTHERS' BELIEFS AND PERCEPTIONS ABOUT SIDS

"Our findings that the African-American mothers in our cohort perceive the link between risk factors and SIDS [sudden infant death syndrome] to be implausible, SIDS to be a random, unpreventable occurrence, and parental vigilance to be the key to SIDS prevention build on findings of earlier studies," write the authors of an article published in the July 2010 issue of the Journal of Pediatrics. Despite the 50 percent decline in the incidence of SIDS in the United States since the first American Academy of Pediatrics recommendations for infant sleep in 1992, African-American infants remain twice as likely to die from SIDS as white infants. To better understand parental decisions and because of the racial disparity seen in both SIDS rates and SIDS-reduction behaviors, the authors of this article conducted a qualitative study of African-American parents using focus group interviews and individual in-depth semi-structured interviews to examine parental beliefs and perceptions about SIDS.

The study sample comprised a cross-section of African-American families with infants from birth to age 6 months in Washington, DC, and Maryland. The authors intentionally recruited families with a broad range of socioeconomic status (SES) to ensure the widest possible range of experiences, influences, and attitudes. The authors selected a purposeful sample of parents, whom they predicted, from their survey responses, would have wide-ranging attitudes and opinions to participate in focus groups and individual interviews. The authors conducted 13 focus groups and 10 individual interviews between July 2006 and December 2008; they asked questions specifically probing parental beliefs and perceptions about SIDS. Data were organized, sorted, and coded, and major themes were identified.

The authors found that

• The three major themes about understanding of SIDS were lack of plausibility, randomness, and vigilance.
• Lack of plausibility: Many mothers did not understand the connection between sleep position and SIDS and did not see this link as being a plausible one. Several mothers did not understand how any risk factors or protective factors could be defined for an entity that is not explained. Furthermore, a number of mothers believed risk reduction to be an absolute concept: you could either entirely eliminate the risk, or you could not eliminate the risk at all.
• Randomness: Most mothers believed that SIDS occurs randomly and that there was nothing one could do to decrease the risk.
• Vigilance. Mothers, particularly those in the lower-SES groups, consistently believed that their own vigilance was the most important factor in preventing SIDS. Sleep position, sleep location, and other sleep behaviors were considered irrelevant as long as the parent was next to and closely watching the infant.
  

The authors conclude that "additional guidance should be provided about roomsharing without bedsharing and other alternatives that will allow parents to maintain vigilance without endangering the infant" and that "if parents are to perceive [safe sleep] messages as being credible and important, there needs to be consistency in the safe sleep messages that are provided by health care professionals and other sources of information for parents."

Moon RY, Oden BL, Joyner BL, et al. 2010. Qualitative analysis of beliefs and perceptions about sudden infant death syndrome in African-American mothers: Implications for safe sleep recommendations. Journal of Pediatrics 157(1):92-97. Abstract available at http://www.jpeds.com/article/S0022-3476%2810%2900042-9/abstract

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• Distress (state anxiety and pregnancy-specific) varied across the three trimesters, with values highest in the first trimester in both groups, then decreasing in the second and third trimesters.
• Women who had a prior miscarriage had higher state anxiety in the second and third trimesters than women without prior miscarriage, but there was no statistically significant difference in the first trimester.
• There was no significant effect of miscarriage history on pregnancy-specific distress in early, mid-, or late pregnancy.
• Having a living child lowered anxiety overall in women without prior miscarriage. The effect was consistent across the three trimesters and was not seen in women with prior miscarriage.

• Over 11.5 percent of singleton, live infants born in 2002 were exposed to prenatal smoking (n=386,262). Compared with women who did not smoke, women who smoked during pregnancy were more likely to be younger, unmarried, less educated, and non-Hispanic white and to have had three or more previous live births, to have initiated prenatal care after the first trimester, and to have had low or high weight gain during pregnancy.
• Prenatal smoking was associated with very-, moderate-, and late-preterm deliveries and term low-birthweight deliveries, compared to term greater than or equal to 2,500 deliveries.
• Prenatal smoking was associated with SIDS and preterm-related deaths.
• A dose response of daily average cigarettes smoked was found for all poor birth and infant death outcomes, and smoking at least 21 cigarettes each day had the strongest association with poor pregnancy and infant outcomes.
• The fraction of adverse birth outcomes attributable to prenatal smoking was 5.3 percent to 7.7 percent for very preterm deliveries, 4.6 percent to 6.7 percent for moderate preterm deliveries, and 2.6 percent to 3.7 percent for late preterm deliveries.
• The fraction of term low-birthweight deliveries attributable to prenatal smoking was 13.1 percent to 19.0 percent.
• The fraction of preterm-related deaths attributable to prenatal smoking was 5.0 percent to 7.3 percent, and the fraction of SIDS deaths attributable to prenatal smoking was 23.2 percent to 33.6 percent.
• The fraction of all infant deaths attributable to prenatal smoking was 2.8 percent to 4.1 percent.

• The frequency of exposure to valproic acid was three times as high among cases as among controls in both groups.
• In analyses of cases and controls in group 1, exposure to valproic acid monotherapy during the first trimester compared with no exposure to antiepileptic drugs during that period was associated with significant increases in the risks of spina bifida, atrial septal defect, cleft palate, hypospadias, polydactyly, and craniosynostosis.
• There were generally similar associations between valproic acid exposure and malformations when valproic acid monotherapy was compared with monotherapy with another antiepileptic drug -- with two exceptions: valproic acid use was not associated with a significantly increased risk of craniosynostosis but was associated with a significantly increased risk of ventricular septal defect.
• In analyses comparing cases with controls in group 2 (those with chromosomal abnormalities), the results were generally similar.
• Separate analyses of the suggested association between valproic acid exposure and limb reduction showed a significantly increased risk of limb reduction compared with the absence of exposure to antiepileptic drugs.