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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.

Readers: The next issue of MCH Alert will be published on November 9, 2012.

Multimedia Featured Resources


Authors Provide Guidance on Talking About Racism and Health Outcomes

Conversations That Matter: A How-To Guide for Hosting Discussions About Race, Racism, and Public Health is intended to help public health professionals open and sustain constructive conversations about the impact of racism on maternal and child health outcomes. The guide was authored by the Lee Institute and commissioned by CityMatch. It is geared for those who already have a working knowledge of racism, public health, and the connection between the two and draws from what is known about skilled facilitation, community building, and holding difficult conversations. Contents include suggestions and resources for one-on-one conversations, group meetings, and planning teams. Woven throughout the guide are suggested practices especially relevant to talking about racism, as well as questions to help readers assess their comfort with the material. The guide is available at http://webmedia.unmc.edu/Community/CityMatch/downloads/fieldguides.swf


Supplement Explores the Developmental Neuroscience of Early Stress and Disadvantage

The October 16, 2012, supplement to PNAS (Proceedings of the National Academy of Sciences of the United States of America), titled Biological Embedding of Early Social Adversity: From Fruit Flies to Kindergartners, comprises papers on the origins and consequences of early social adversity presented at the December 2011 Arthur M. Sackler Colloquium. Following an overview of the field and its challenges, the papers address a range of social contextual stressors, ranging from poverty and deprivation to acute and chronic life stress to the experiences of societal stratification, subordination, and social network affiliation. Topics include a survey and critique of the literature linking socioeconomic status and health and a historical perspective on how early socioeconomically graded adversities become biologically embedded. Additional topics include advances in understanding central and peripheral neural responses to psychosocial stressors; the impact of early experience on social, perceptual, and cognitive systems; how inherited and environmental factors work together to shape both adaptive and maladaptive developmental and behavioral outcomes; and the health consequences of social position and relationships. Taken together, the contributions to this special issue tell an emerging story of importance to those concerned with the physical embodiment and health consequences of early social conditions. The nascent but now substantial and increasingly coherent story traces many of the chronic morbidities, behavioral proclivities, and lasting afflictions of adulthood to experiences of adversity, maltreatment, and subordination sustained over the early years of life. The supplement is available at http://www.pnas.org/content/109/suppl.2


Article Reviews SUID, SIDS, and Fatal Child Abuse and Neglect in the Emergency Department

Sudden Unexpected Infant Death: Differentiating Natural from Abusive Causes in the Emergency Department provides guidance on reporting and evaluating sudden unexpected infant death (SUID) for pediatric emergency physicians, general emergency physicians, general pediatric physicians, and family physicians working in emergency departments. The continuing medical education review article, published in the October 2012 issue of Pediatric Emergency Care, addresses the diagnostic, public health, and child welfare implications differentiating sudden infant death syndrome and fatal child abuse. Topics include evaluating the demographics and etiologies of SUID, assembling the information needed from the history and physical examination of SUID cases to aid medical examiners' forensic investigations, and distinguishing which SUID cases are more likely to be deaths due to child abuse and neglect.

Bechtel K. 2012. Sudden unexpected infant death: Differentiating natural from abusive causes in the emergency department. Pediatric Emergency Care 28(10):1085-1089. Abstract available at http://journals.lww.com/pec-online/pages/default.aspx


Study Identifies Factors That Mediate Racial and Ethnic Disparities in U.S. Fetal Death

"We found persistent, increased rates of fetal deaths in Black, Hispanic, and Asian women compared with non-Hispanic White women. However, this increase appears to be mediated by different factors between racial/ethnic groups," write the authors of an article published in the October 2012 issue of the American Journal of Public Health. In the United States, racial and ethnic disparities in perinatal outcomes, such as fetal death, persist. The study described in this article identified factors that mediate racial and ethnic differences in fetal death rates between 23 and 44 weeks' gestation and grouped the factors into four categories: socioeconomic factors; preexisting co-morbid conditions; antepartum and intrapartum factors, primarily complications of pregnancy; and fetal factors, specifically gestational age at delivery. The goal of the study was to determine the importance of these factors in mediating racial disparities in fetal deaths.

The authors obtained data from all hospital deliveries occurring in California, Missouri, and Pennsylvania between January 1, 1995, and June 30, 2005, with gestational ages between 23 and 44 weeks, including fetal death, live birth, maternal hospital discharge records, and newborn hospital discharge records. These data allowed the authors to compare women with fetal deaths with women with live births. There were 110,264 births that met exclusion criteria, leaving 710,674 births in the final cohort. The primary outcome for this study was a pregnancy that ended with a fetal death.

The authors found that

The authors conclude that "because it may be difficult to achieve changes in many lifetime processes that may underpin differences in reproductive outcomes, these findings suggest that interventions targeted to specific mediating factors occurring during pregnancy may help reduce fetal death disparities in the United States."

Lorch SA, Kroelinger CD, Ahlberg C, et al. 2012. Factors that mediate racial/ethnic disparities in US fetal death rates. American Journal of Public Health 102(10):1902-1910. Abstract available at http://ajph.aphapublications.org/doi/abs/10.2105/AJPH.2012.300852

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


Study Evaluates Effect Of Marital Status On Risk For Prematurity, Stillbirth, Infant Death, And Sids

"Our results suggest that the rate of nonmarital childbearing has risen over the 10-year period from 1995 until 2004 and that pregnancies among unmarried women are associated with an increased risk of prematurity and fetal and infant mortality, including SIDS [sudden infant death syndrome]," state the authors of an article published in Women's Health Issues online on June 20, 2011. Current theories linking marital status and birth outcomes include a lack or reduced levels of psychosocial support and relationship stability for unmarried women; increased exposure to risky behaviors; and social stigma surrounding what may be considered illegitimate births. Although some studies have evaluated the effect of marital status on pregnancy outcomes, they have not been powerful enough to evaluate the effect of marital status on rarer outcomes such as fetal, neonatal, perinatal, and infant death, including SIDS. The article presents findings from a large, population-based cohort study to determine the association between marital status and fetal and infant death, while identifying risk factors among unmarried women that may be associated with these outcomes.

Data for the study were drawn from the Birth Cohort Linked Birth-Infant Death and the Fetal Death data files from the National Center for Health Statistics. The researchers assembled a 10-year cohort using data for the years 1995 to 2004. Exposure was defined as married or nonmarried as indicated in the reported marital status category within the database. Outcomes included premature births, stillbirths, and infant deaths. The research determined whether there was a trend in the rate of nonmarital childbearing and the relationship between marital status and outcomes. The researchers evaluated the effects of marital status on the outcomes while adjusting for confounders (maternal age, race, and education) and causal intermediates (plurality, prenatal care, and adequacy of care) on the exposure-outcome relationship. Finally, to identify predictors of fetal and infant death among unmarried women, the researchers examined the effect of specific baseline characteristics on fetal and infant death in an analysis restricted to unmarried women.

The authors found that

"With the increased risk of stillbirths and infants deaths associated with nonmarital childbearing . . . unmarried mothers-to-be may be targeted with the goal of educating, increasing awareness, and providing resources for proper obstetrical and maternal care," the authors conclude.

Balayla J, Azoulay L, Abenhaim HA. 2011. Maternal marital status and the risk of stillbirth and infant death: A population-based cohort study on 40 million births in the United States. Women's Health Issues [published online on June 20, 2011]. Abstract available at http://www.sciencedirect.com/science/article/pii/S1049386711000855

Readers: More information is available from the National Sudden and Unexpected Infant/Child Death and Pregnancy Loss Resource Center as follows:

- Infant Mortality and Pregnancy Loss: Knowledge Path at
http://sidscenter.org/infant_mortality.html


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MCH Alert © 1998-2012 by National Center for Education in Maternal and Child Health and Georgetown University. MCH Alert is produced by Maternal and Child Health Library at the National Center for Education in Maternal and Child Health under its cooperative agreement (U02MC00001) 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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EDITOR/ADMINISTRATOR: Jolene Bertness, M.Ed.
CO-EDITOR: Tracy Lopez, M.S.L.S.
COPYEDITOR/WRITER: Ruth Barzel, M.A.

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