MCH Alert: Focus on Infant Mortality is developed by the Maternal and Child Health Library in collaboration with the National SUID/SIDS Resource Center at Georgetown University. This and past issues of the MCH Alert are available at http://www.mchlibrary.info/alert/archives.html and http://www.sidscenter.org/alert/archives.html
1. Brief Features Health Plans and Foundations That Address Preconception Health
Health Plan Approaches to Preconception Health examines the role of private health plans and their philanthropic foundations in promoting preconception health. The issue brief was published by the National Institute for Health Care Management Research and Educational Foundation with support from the Health Resources and Services Administration's Maternal and Child Health Bureau. Topics include motivations for health plan and foundation interest in preconception care and their strategies to increase access to preconception care and document how these approaches are reaching women of childbearing age. The brief concludes with a summary of remaining barriers, along with potential strategies for overcoming the barriers and promoting preconception health. The brief is available at http://nihcm.org/images/stories/Final_Preconception_Issue_Brief_electronic_version.pdf
2. Article Analyzes Characteristics and Sleep Circumstances of Infants Who Die Suddenly and Unexpectedly
“Our descriptive analysis of population-based multistate CDR [child death review] program data showed that only one quarter of SUID [sudden unexpected infant death] victims were sleeping in a crib or on their back when found; 70 [percent] of infants were on a surface not intended for infant sleep, and 64 [percent] with documentation of their position when found were on their stomach or side,” write the authors of an article published in the June 2012 issue of the American Journal of Public Health. Each year in the United States more than 4,000 infants without prior known illness or injury die suddenly and unexpectedly. More than half of SUIDs are ultimately classified as resulting from sudden infant death syndrome (SIDS). The comprehensive compilation of relevant risk factors available in the National Child Death Review Case Reporting System (NCDR-CRS) presents a unique opportunity to examine the circumstances of SUIDs in the United States. The authors used these population-based multistate CDR program data to describe the characteristics and sleep circumstances of infants who die suddenly and unexpectedly and to assess similarities and differences in SUID risk factors among infants whose deaths are ultimately classified as resulting from SIDS, suffocation, or undetermined causes.
The authors used data from nine states enrolled and entering data in the NCDR-CRS (California, Delaware, Hawaii, Michigan, Nevada, Ohio, Pennsylvania, Tennessee, and Texas). The study population included infants (defined as younger than age 1) who died between January 1, 2005, and December 31, 2008; whose death was identified as occurring while sleeping or in a sleeping environment; and whose cause of death, as recorded in the NCDR-CRS, was accidental asphyxia, SIDS, undetermined, or unknown. There were 3,136 SUIDs available for analysis.
The authors found that
The authors conclude that “future research should focus on development of novel interventions that facilitate behavior change and result in a safe infant sleep environment.”
Schnitzer PG, Covington TM, Dykstra HK, et al. 2012. Sudden unexpected infant deaths: Sleep environment and circumstances. American Journal of Public Health 102(6):1204-1212. Abstract available at http://ajph.aphapublications.org/doi/abs/10.2105/AJPH.2011.300613
Readers: More information is available from the following National SIDS/SUID Resource Center web page:
- Safe Sleep at
http://sidscenter.org/SafeSleep/index.html
3. Research Examines Different Levels and Patterns of Prenatal Alcohol Consumption and Spontaneous Abortion
"Consistent with our hypotheses, a significant relation between alcohol use [per] day across pregnancy . . . and spontaneous abortion (SAb) was identified in this selected sample of high-risk, urban African-American women," write the authors of an article published in the May 2012 issue of Alcohol. Alcohol consumption during pregnancy is a risk factor for many adverse outcomes. Pregnancy complications including SAb, stillbirth, and preterm delivery related to increased consumption of alcohol during pregnancy have been reported, although findings are mixed and in some cases conflicting. The current study examined the association of alcohol consumption with SAb in a prospective sample of women (n=302) recruited on the basis of their self-reported peri-conceptional alcohol consumption. The authors hypothesized that higher average alcohol-consumption levels across pregnancy in this sample -- drinking more alcohol per drinking day, binge patterns of prenatal drinking, and more frequent drinking -- would be associated with increased rates of SAb, compared with lower alcohol-consumption levels.
The study sample was a subset of a larger cohort of women who were participants in a study of the long-term effects of prenatal alcohol consumption and undernutrition on perinatal development. The women were initially recruited at their first antenatal visit to a large urban maternity clinic serving primarily African-American women. The current study included all women reporting peri-conceptional alcohol consumption averaging at least 1 oz of absolute alcohol per day (the equivalent of about two drinks per day, on average). Women who consumed low levels of alcohol and those who abstained from alcohol consumption were chosen randomly from the total sample and formed the comparison group. The analyses assessed the relationship between alcohol variables and pregnancy outcome (SAb vs. no SAb), controlling for maternal age, maternal education, socioeconomic status, marital status, and prenatal exposure to cigarettes (number smoked per day).
After controlling for multiple demographic characteristics and other prenatal exposures, including smoking, the authors found that
"The current study identified increased risk of SAb at relatively low levels of alcohol use, and with a relatively small frequency of alcohol drinking across pregnancy," conclude the authors. They add, "it is incumbent upon prenatal care providers to identify, address, and seek to reduce pregnancy alcohol use in their patients."
Chiodo LM, Bailey BA, Sokol RJ, et al. 2012. Recognized spontaneous abortion in mid-pregnancy and patterns of pregnancy alcohol use. Alcohol 46(3):261-267. Abstract available at http://www.alcoholjournal.org/article/S0741-8329(12)00031-6/abstract
Readers: More information is available from the following MCH Library resource:
- Tobacco, Alcohol, and Substance Use During Preconception and Pregnancy: Resource Brief at
http://www.mchlibrary.info/guides/substancepregnancy.html
4. Study Explores Epidemiology of Infant Death in Hampton Roads, Virginia
"Overall evidence suggests that black infants were at increased risk of dying in the first year of life when compared with white infants in Hampton Roads, Virginia," write the authors of an article published in the May 2012 issue of the Southern Medical Journal. The Hampton Roads region is in the southernmost part of Virginia. It has one of the largest seaports in the United States and a heavy military presence. It is the 4th largest metropolitan area in the Southeast and the 35th largest in the United States, with an estimated population of 1.7 million. Current evidence suggests that, irrespective of racial group, the infant mortality rate (IMR) in Hampton Roads is the highest in Virginia and is consistently higher than national IMR estimates. The article examines racial disparities in IMRs and risk factors for infant death within racial groups in Hampton Roads, Virginia.
Data for the study were drawn from the Virginia Department of Health's (VDH’s) Division of Vital Statistics linked infant birth/death records for Hampton Roads. The electronic file comprised 9 years of data (January 1, 1999, through December 31, 2008). There were 201,610 live-born infants for the period (84,084 black infants and 117,526 white infants) and 1,659 infant deaths (1,020 black infant deaths and 639 white infant deaths).
The authors found that
"Continued efforts should be targeted at addressing the complex issue of prenatal care accessibility for mothers and reducing the prevalence of preterm delivery and low birthweight infants," conclude the authors. They add, "black women should be a group that is offered additional support and outreach because they are disproportionately affected by infant mortality in Hampton Roads."
Emuren L, Shauhan S, Vroman R, et al. 2012. Epidemiology of infant death among black and white non-Hispanic populations in Hampton Roads, Virginia. Southern Medical Journal 105(5):259-265. Abstract available online.
Readers: More information is available from the following MCH Library resources:
- Infant Mortality and Pregnancy Loss: Knowledge Path at
http://www.mchlibrary.info/KnowledgePaths/kp_infmort.html
- Racial and Ethnic Disparities in Health: Knowledge Path at
http://www.mchlibrary.info/KnowledgePaths/kp_race.html
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