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
Multimedia Featured Resource: The Pennsylvania Chapter of the American Academy of Pediatrics (AAP) hosted the webinar, Let's Talk: Infant Safe Sleep, on May 22, 2012. The webinar explained what sudden unexplained infant death and sudden infant death syndrome (SIDS) are, described the statistics on SIDS and accidental sleep deaths, explained the most recent AAP recommendations on SIDS risk reduction, and provided information about promoting infant safe sleep to families. The webinar recording and related resources are available at http://paaap.org/show_event.php?eventid=ltt_safesleep_05222012.
1. Paper Explores the Concept of Health-Literate Health Care Organizations
Ten Attributes of Health Literate Health Care Organizations outlines features of health care organizations that make it easier for people to navigate, understand, and use information and services to take care of their health. The discussion paper, co-authored by participants in the activities of the Institute of Medicine Roundtable on Health Literacy, demonstrates how organizations can take action to close the gap between individuals' health literacy skills and the demands of complex health care systems. It highlights opportunities to redesign health information and services, integrating principles of health literacy into organizational objectives, infrastructure, policies and practices, work force development, and communication strategies. Contents include a brief elaboration of the meaning of and basis for each of ten attributes, followed by a set of implementation strategies that can be used to achieve the attributes. The paper is available at http://iom.edu/~/media/Files/Perspectives-Files/2012/Discussion-Papers/BPH_Ten_HLit_Attributes.pdf
2. Authors Report Estimated Pregnancy Rates and Rates of Pregnancy Outcomes, 1990-2008
"Persistent differences in pregnancy rates by race and Hispanic origin and by pregnancy outcome have continued," write the authors of the June 20, 2012, issue of National Vital Statistics Reports. This report presents revised pregnancy rates for 2000-2005 and new rates for 2006-2008 for U.S. women through age 44. Rates are presented for pregnancy outcomes (live birth, induced abortion, and fetal loss), by age, race, and Hispanic origin, and by marital status. The data in this report for 2000-2008, together with previously published pregnancy rates for earlier years, provide a consistent series of rates for the United States for 1976-2008.
The authors found that
The report contains a discussion of some of the factors underlying pregnancy rates. Some of these factors include changes in sexual activity; changes in marriage, divorce, and cohabitation; the introduction of new contraceptive methods and the discontinuation of previously existing ones; and changes in the use of available methods. "Data from the 2006-2010 NSFG [National Survey of Family Growth] can be used to provide context on some of these underlying factors accounting for trends and variations in pregnancy rates," the authors conclude.
Ventura SJ, Curtin SC, Abma JC, Henshaw SK. 2012. Estimated pregnancy rates and rates of pregnancy outcomes for the United States, 1990-2008. National Vital Statistics Reports 60(7):1-21. Available at http://www.cdc.gov/nchs/data/nvsr/nvsr60/nvsr60_07.pdf
3. Review Looks at Causal Mechanisms Explaining the Effects of Birth Spacing on Health
"The results of our review indicate that, overall, no clear evidence exists for explaining the mechanisms through which both short and long intervals between pregnancies are associated with increased risk of adverse maternal, perinatal, infant, and child outcomes," state the authors of an article published in the June 2012 issue of Family Planning. Evidence from systematic reviews and meta-analyses indicates that short and long intervals between pregnancies are independently associated with increased risk of adverse maternal, perinatal, infant, and child outcomes. However, the mechanisms by which pregnancy intervals may affect health have been the subject of much debate. The article presents findings from a study to systematically collate, appraise, and synthesize the literature on this topic.
The investigators used a prospective protocol to identify hypothetical causal mechanisms for explaining the effects of short and long intervals between pregnancies on maternal, perinatal, infant, and child health. They searched Medline, Embase, CINAHL, Popline, and LILACS (all from inception to June 30, 2011) using a combination of terms related to birth spacing and causal mechanisms. During their initial search, the researchers identified ten hypothetical causal mechanisms for explaining the association between pregnancy intervals and adverse outcomes and then conducted a second search using terms related to each hypothesized causal mechanism identified. Fifty-eight studies were included in the review.
In summary, the authors found
"Based on the findings of this systematic review, we have constructed a conceptual framework, which, although insufficient for generating causal inferences, provides a starting point for generating and supporting hypotheses regarding the mechanisms through which short intervals between pregnancies affect maternal, perinatal, infant, and child health," conclude the authors.
Conde-Agudelo A, Rosas-Bermudez A, Castano F, et al. 2012. Effects of birth spacing on maternal, perinatal, infant, and child health: A systematic review of causal mechanisms. Family Planning 43(2):93-114. Abstract available at http://dx.doi.org/10.1111/j.1728-4465.2012.00308.x.
Readers: More information is available from the following MCH Library resource:
- Preconception and Pregnancy: Knowledge Path at
http://www.mchlibrary.info/KnowledgePaths/kp_pregnancy.html
4. Article Evaluates Disparities in Fetal Death and First Day Death
"Despite general improvements in fetal and early infant mortality, racial disparities persisted and improvements in fetal mortality over time among Blacks, when adjusted for maternal characteristics, were not significant," write the authors of an article published in the American Journal of Public Health online on June 14, 2012. In the United States, there have been improvements in perinatal (fetal plus infant) mortality over the past few decades, with a 56 percent decline overall from 1970 (14.0 per 1,000 live births plus fetal deaths) to 2005 (6.2 per 1,000 live births plus fetal deaths). However, substantial disparities remain and in some cases continue to grow. The purpose of the study described in this article was to examine how changes in maternal, sociodemographic, and medical risk factors over time influence changes in fetal, first day, and combined fetal-first day (fetal plus first day) mortality. The authors explored racial and ethnic variations and disparities and risk factors as related to mortality outcomes. They chose to look at first day deaths in combination with fetal deaths because an artificial reduction in fetal deaths may account for a rise in infant deaths. Events once classified as fetal deaths may now be classified as first day deaths, reflecting misclassification of the timing of death; changes in management of the delivery of very small, very early fetuses; or overall changes in baseline health.
The authors used data from the National Center for Health Statistics 1995-1996 and 2001-2002 linked live birth and infant death cohort files as well as the fetal death files from the same years. They analyzed 11,353,250 deliveries (n = 5,755,053 in 1995-1996 and n = 5,598,197 in 2001-2002). They excluded Hispanics because of the high percentage (almost 40 percent) of missing information on smoking. Because of missing data on selected characteristics, the final sample size for some analyses was smaller.
The authors found that
The authors conclude that "discrepancies in access to care as well as other more contextual issues such as stress should be considered when one is evaluating disparities."
Wingate MS, Barfield WD, Petrini J, et al. 2012. Disparities in fetal death and first day death: The influence of risk factors in 2 time periods. American Journal of Public Health (published online on June 14, 2012). Abstract available at http://ajph.aphapublications.org/doi/abs/10.2105/AJPH.2012.300790.
Readers: More information is available from the following MCH Library resource:
- Racial and Ethnic Disparities in Health: Knowledge Path at
http://www.mchlibrary.info/KnowledgePaths/kp_race.html
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